NORTHERN NSW YOUTH HEALTH CONSULTATIONSeptember 2016

Forty-one participants attended the Youth Health Workshop; participants came from various locations from within the Local Health District including smaller communities, remote inland communities and larger coastal and regional towns. Participants came from Bonalbo, Alstonville, Ballina, Lismore, Nimbin, Coffs Harbour, Casino, Goonellabah, Murwillumbah, Brunswick Heads, Byron Bay, Lismore, Uralba, Kyogle, Brisbane, Ocean Shores and Billinudgel. The diversity of the community was also reflected in having a number of participants from Aboriginal or Torres Strait Islander background and participants with ongoing health conditions. Participants ranged in age from 13 to 24 years of age. The workshop was facilitated by Peter Chown and included group discussion and interaction around five key topics: Health and Health Issues, Access to Services, Service Providers, Diversity and Youth Participation and Health Promotion and Online Services/Resources. Uncle Lewis Cook, Bundjalung Elder provided a Welcome to Country and participant Seth Freeman played the Digeridoo. The day also included performances from and discussion with the Byron Bay Youth Theatre Group.

Health and Health IssuesWhat does being ‘Healthy’ mean to you? What are some specific health problems young people experience – what do you think are the main health problems and issues for young people, particularly your age group? What do you need to be healthy?

Four key themes emerged from these questions Being Healthy, Social Connection, Mental Health and Drugs and Alcohol.

“Health is everything physical and intellectual”

Being healthy included a range of ideas including eating well, getting enough sleep, exercise, being happy, having strategies for coping, speaking up, dealing with negative thoughts and connectedness to Land and Culture. Having adequate resources, security and connection to food from the earth were seen as important aspects for being healthy.

Social connection was around school education, social interaction, access to services and transport, access to school counsellors, out of school community groups and having healthy relationships were highlighted. This included aspects such as helping others, having healthy relationships and being able to speak up and let others know how your feel. A number of participants spoke about not letting others put you down as being important. Access to GPs, medical services and staying contact with your doctor were also mentioned.

“Mental Health not taken seriously”

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Main issues mentioned around Mental Health related to stigma, anxiety, mental health not being talked about or being swept under the carpet, lack of services in rural and remote communities (having to travel for services), access to school counsellors and self-harm.

Similarly, issues relating to use or abuse of Alcohol and Drugs included: fear based education, stigma in seeking help, lack of clarity and safe access of information to make informed choices, confusion over what is socially acceptable i.e. Alcohol is advertised and self-harm.

Other key points raised: were a general feeling of Stigma against youth i.e. all youth are lazy, need for Sexual Health Education and too much time spent in front of computer/phone screens.

“Understanding body and mind”

To be or keep health requires money and resources to buy what you need, skills to build good relationships and know what is right from wrong, school/work life balance (manage stress), support after school and during transition from school to study or work, access to reliable information, opportunities to contribute, acceptance and feeling safe and listened too.

Access to ServicesWhere can young people go for help or advice with their health problems? What are some of your experiences in using a health service? What are the main barriers young people experience in getting help for their problems or using available health services? How could these barriers to young people using health services be overcome? Discuss any experiences you have had using ‘online services’ (e.g. websites, apps or social media sites) where you can interact with a health professional or get health information? How would you find out what health services are available or decide where to go for help?

Considerable discussion around issues of access, confidentiality, stigma, choice, information access, support and affordability, with the issue of rurality deepening the effect of all these issues.

The interconnectedness of services was seen as important and again the impact of being in smaller and more remote communities where travel to services was highlighted. This was further impacted with a lack of mobile/internet access in these communities. Linkages between Dental, General Practice, Specialists and Hospitals was raised. Availability and affordability of services, lack of transport, anonymity and choice were also raised as significant issues to access for these communities.

Issues around the gender of single parent families, access to school counsellors, need for targeting at risk youth, and teen pregnancy were also raised.

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“How can we get better information out to young people”

Service Providers

“What have your experiences been (good and bad) of seeing a health professional – such as a doctor; counsellor; etc.” What qualities are important in a health professional that would make them a youth friendly’ service provider? What advice would you give to health professionals about young people’s needs and how you want to be treated? What training and skills do health professionals need to be effective in working with young people?

General discussion ensued with many experiences shared and the effectiveness of treatment provided and the importance of communication engagement expressed by the group regarding Service Providers these included a range of options included in the following points:

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Dentist GP Hospital Access Money Gender single parent families Stigma Transport Choice Inter-connected services Different in different localities Anonymity Specialist support expensive Lifestyle social issues School counsellors Teen pregnancy Empathy Lack of confidence Too scared Don’t know who to talk to RAP song for support Drug and Alcohol Issues – peer group not part of

culture At risk youth Access to doctors in regional areas Reduced confidentiality in rural areas Lack of internet Travel Confidence Someone you could meet to support peer support More young person’s working in services

Confidentiality – personal questions often asked of youth in a condescending manner and not respecting privacy especially in small communities where everyone knows everyone!

Not feeling safe in environments re the atmosphere, body language and attitudes of the Health Professional.

A welcoming environment youth friendly is always what should be available to youth.

An unpleasant first experience visiting a Health Professional will stay with you always and therefore stops future engagement or confidence in seeing them again.

Lack of empathy. Stigma often associated with youth, not taken seriously with health problems for

eg mental health, anxieties, illnesses because we are young we will grow out of it.

Waiting times can be frustrating when waiting on appointments or in an ED. GP’s not equipped to work with youth. School counsellors are often the confidante and there should be more

encouragement through schools for youth who are undergoing health issues to visit a GP.

Young people want Health Professionals to treat them as equals. Doctors should be open and not judgmental. Doctors should use simple language and explain things. The same gender as one self re the Drs this is often more a preferred and

comfortable option. Continuity of care seeing a regular Health Professional who you can gain trust

with and build relationships with. Allowing young people to make decisions. Culturally appropriate don’t ever assume we are ok. Youth Services could be more available and provide informative information so

choices can be made with which Dr a young person may choose to go too especially based on their speciality.

Holistic care. Rural areas do not always have options such as transport, naturopaths and

facilities may be vast and in remote locations for eg with our group today there was an overabundance of services in the Byron Bay area however compared to Bonalbo who has very limited services and youth have to travel to gain these services.

Some Medical clinics could accommodate having volunteer programs where young people can work and learn about health issues and also advise medical centres on what young people would like when visiting a Dr.

Feeling respected is important to our well-being. Expensive if bulk billing is not available and specialist appointments are very

expensive if your family cannot afford them. Look at more preventative courses rather than treatment. GPs should be more aware of individuals needs when they are referring on

especially to psychologists. Dentists don’t ask questions it may be “open your mouth” and that is the extent of

conversation and they can be scary and an unpleasant experience like judging you if you don’t floss etc! and they are expensive.

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Not put or treated in a child’s room or adult room but more age appropriate surrounds.

Help to seek help for medical reasons. We don’t often know who to go too if our parents are not around.

Age of Drs sometimes difficult to deal with if they are much older then you. Positivity from the Dr, an example provided by a young person in the Casino area

who sought mental health services and the Dr was great, gave them sound advice to help deal with a difficult situation without prescribing medication. A great experience because I was aware of my symptoms and how to deal with them when they occurred again.

Head Space is great organisation they helped me lots. Difficult to get into see a Dr if not a regular client. Feeling cared for and reassured is very important. Treat me not my parents. It would be great if Drs were updated on youth and understanding their concerns

and upskill towards this. The Doctor adapting to the client and not the client to the Doctor. So many young people do not know about organisations that can help them such

as PASH, Drug and Alcohol services, programs such as teenage pregnancies, quit smoking etc.

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Recommendation by the Group

“that more succinct bio’s for Health Professionals should be developed and/or on an app on your telephone or computer, re information about Doctors and all Health

Professionals which could be made available via their websites or a printout/brochure at the medical centres when visiting. This would provide information to include who they are, youth friendliness, specialisations, what can you do for me? how can you

relate to me? Respect for cultural, spiritual, sexual and personal situations”.

Diversity and Youth Participation

“Some young people are at higher risk of poor health because they come from diverse backgrounds or have specific health issues – What are some of their needs? Are there different needs for young men and young women? Discuss any experiences you have had in participating in health services, programs or activities? How could we support young people to have a voice about their health care and greater opportunities of participation?

Engagement by the Group provided a range of information regarding this and discussion included the following points:

Indigenous youth often carry the grief and sorrow inherited from their elders and families and they experience the difficulties of living in two worlds which can attribute to poor health and education not fitting into mainstream.

Misbehaving in school may be due to poor sleep, diet, no roles models at home to discipline meals, sleep, social behaviours.

Lack of adult role models. Lack of respect for authority can be harmful if health professionals try to help. Generations where poor health due to low incomes or on unemployment and

welfare cause health problems, as parents cannot afford to take their children to Drs or to buy better quality healthy food.

Lack of education and making informed decisions. Males and females have different social and mental health needs for eg

contraception, having babies, personal hygiene products. Religious intolerance and other culture’s beliefs and trying to fit in, often not

acceptable to others

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LGBTI communities and their rights can be seen as controversial. Access to services which may help get better health are not available. No parent support, living with carers and/or homeless. Stereotyping young people is very common. Poor attendance at school where young people can be educated and shown

better ways of living, eating, looking after their health needs. Improvements in health services and programs such as suggested audit and

accountability of Practitioners. Online reviews are a good “go to”. App for local health services reviewed by young people. More specific adolescent trained psychologists Ability to understand you. Mental Health Nurses we need more of them. Hospitals need more trained staff couldn’t more money be spent on youth health

than on defence funding? More online sites such as counselling services, more funding and resources for,

Kids Helpline, SMS messaging to phones, Beyond Blue, Headspace, Black Dog. Finding out about health services by google, parents, school, government

Initiatives for carers, teenagers, Culturally and Linguistically Diverse CALD a need to raise awareness.

Peers helping one another especially at school. Limited number of mental health sessions is 12 over a 12-month period, which is

not enough to cater for needs especially if someone is going through trauma, grief, depression

Vulnerable people are prone to abuse if they are not supported. Transport issues. Transgender issues require specialised services. More youth forums such as this. A need to reduce the stigma of mental health issues as youth are afraid to

approach for help. A need for change and feedback to make a change is acted on by Authorities

such as Health, Government etc. Importance of mentoring youth in every situation. Acute needs not always met in rural areas, have to move to larger towns to get

the help and treatment required. Building relationships hearing young people have their voices heard. Sense of humour very important when dealing with young people to relate better

about things builds trust and is genuine. Like-minded people share their experiences learn from one another, just like

today! Lots of pressure on appearances and looking good. Domestic violence sometimes at home or known to be occurring at homes of

peers. More collaboration between health services and the pathway to following up on

these. Birth control, personal hygiene, medications, vaccinations, freedom of choice to

elect what is right for you! Catchy advertisements, promoting health, start the conversation. Byron Bay Youth Theatre, everyone loves this concept to visually explain what

we go through.

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Good communication must be promoted. Medicare rebates should be more affordable Regimented hours often difficult with school and working if you are trying to get to

a Dr between set hours be more accommodating and flexible to youth! More Agencies should visit schools make students aware of Services available to

help them. Limited access to internet, educational opportunities. Ambassadors for mental health and general health should be promoted and

encouraged more with youth!

Health Promotion and On-Line Resources

What health information activities are you aware of and how effective are they for young people? What on-line health resources do you know about or have used? What are your experiences of these sites? What are the benefits/advantages of using online services/websites? What health issues would you prefer to use an on-line resource for? What would make it easier for you to access and use health information or online resources?

Examples discussed by the Group included the following discussion points:

Programs such as Quit for Life, PASH, ICE advertisements, Youth Advisory Councils, informed people for example sporting or role models making the message upfront but fun for ex sexual advice, drug abuse, social behaviour, bullying etc.

YouTube presentations. Social marketing gets messages out there! Fear campaigns, drink driving implications. RBT – Name and shame. Personalise advertising, send a positive message that everyone is not the same. Develop quality health and lifestyle programs with a positive message and have

more of a focus on youth participation in modelling and designing models of health for young people.

Bureaucratic approach will not work with young people. Suggestions with youth forums to include the diversity of young people’s

individual experiences, people demand respect and youth should be having more of a say into general services that are offered to the public even through politicians.

Promote Advocates and young spokespeople. Engagement of mentors and role models is very important particularly at school,

who do we go too?

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“If I am going to trust you as a Health Professional, you need to provide a safe place where I can feel I can express myself without criticism, without judgement, because

my world and my experience is unique. If we can meet on some common ground with common language and you understand me and I can understand you then we are on the road to better outcomes for us both and we can move forward to a healthy me.”

Some young people have experiences accessing Tumbler (self-harm sites) due to their mental instability. This site changes depending on how you use it and who you follow.

Access to programs needs to be affordable and accessible to young people. Specific education for life skills is needed in schools and further education

resources. Visual displays getting messages out there to youth such as the Byron Youth

Theatre group through acting and music, we loved this production shown today!. Involve young people in developing social media advertising for example,

pictures of people shoplifting, name and shame adverts. Focusing on how you will get caught and have a criminal record, which “is not cool”.

Some social media advertisements have a message of “don’t do it” and young people may defy this by “wanting to do it’ often to see what happens.

Facebook is a mighty tool but it can also attract bullying, more education is needed around social media such as this application.

Some young people can be desensitised to shocking advertisements such as car accidents on television, health problems if you smoke for example pictures on cigarette packets etc.

Some young people do not have the experience of knowing if websites are trustworthy.

Suggestions for NSW Health to develop an App for young people such as “Tinder for Drs” and easy access to bios of Drs to link in to youth services. Young people should be able to then place reviews on blogs about their experience with a Dr Health Professional on this.

Attitude of Health Care Workers are often out of date to what is happening with young people today! Therefore, employers should promote youth forums and feedback and listen to us!

More research is required by Organisations into youth issues Embrace modern technology and promote it for health services in general and

young people will gain the confidence to use these and be more informed. Make online services free to access as many young people come from very

diverse social and economic disadvantaged circumstances.

In Summation

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“The Youth Forum today many felt pleasantly surprised by the format of the day, and this type of forum was invaluable and an ideal situation because young people shared experiences and engaged and interacted in a group through discussion. The pleasant and friendly environment, the respect of the Facilitators and mentors in providing help if needed around discussion,

mental health concerns, sexual identity, eating disorders, pressure of school getting good marks and results and it was very inviting and comfortable and

we would all come back again.”

The general consensus from the Youth present at the Forum in Ballina today is they have learnt a lot from the day, are more aware of health services and systems to access what is available and will take away lots of information. Feedback from the young people was it was great to participate in a group forum that had a youth focus and to meet so many young people here from diverse backgrounds and share our experiences. The group thanked the facilitator Peter Chown, the scribes, Carmen and Sally NSW Kids and Families and we particularly loved the Byron Youth Group, it was “awesome” thanks to Lisa for organising the production.

As a group a key message is that youth have specific health needs and often face barriers and are placed in vulnerable situations when using health services because we are simply young people and we have a voice which needs to be heard. Youth want to see more youth friendly services and be encouraged to have better health outcomes through positive relationships with health professionals to reach positive outcomes and achieve lifestyle goals. Early intervention through supportive resources that reach all youth such as education and mentoring, will help us achieve confidence and provide better health outcomes.

Participants were keen for some ongoing dialogue or opportunity for engagement with health to be developed.

As a Group we hope this feedback finds its way to contributing to “Towards the Next Youth Health Policy Consultation Paper”.

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