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ED 460 321 CG 031 069

TITLE AusEinetter, 1999.INSTITUTION Australian Early Intervention Network for Mental Health in

Young People, Bedford Park, South Australia.SPONS AGENCY Australian Commonwealth Dept. of Health and Family Services,

Canberra.ISSN ISSN-1329-8720PUB DATE 1999-00-00NOTE 22p.; Two issues were produced in 1999. For the 1998

issues, see CG 031 068.AVAILABLE FROM Australian Early Intervention Network for Mental Health in

Young People, C/- CAMHS Southern, Flinders Medical Center,Bedford Park, South Australia 5042. For full text:http://auseinet.flinders.edu.au.

PUB TYPE Collected Works - Serials (022)JOURNAL CIT AusEinetter; n8-9 1999EDRS PRICE MF01/PC01 Plus Postage.DESCRIPTORS Adolescents; Children; Foreign Countries; Indigenous

Populations; *Intervention; *Mental Health; NationalPrograms; Prenatal gare; *Prevention; Program Evaluation;Suicide

IDENTIFIERS Australia

ABSTRACTThis document contains issues eight and nine of the 1999

Australian Early Intervention Network for Mental Health in Young Peoplenewsletters for health professionals. The newsletters disseminate informationabout the national and local initiatives for intervention and prevention ofmental health problems in young children and youth. The issues featureinformation on the evaluation and effectiveness of several programs; consumerinvolvement in health care; available resources; and news on upcomingconferences. Guest editorials include: "Suicide Prevention: Changing the'Tipping Point'" (Robert Goldney); "Indigenous Health and EarlyIntervention--Addressing and Acknowledging the Influences of the Past" (ShaneMerritt); "Early Intervention and Perinatal Mental Health" (Stephen Matthey);and "Early Intervention: From Rhetoric to...?" (Cathy Davis). (Contains 19references.) (JDM)

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ISSN 1329-8720Issue 8, March 1999 - No 1/99

Gasesit &Muria§ProVessor Rabaul Goildney&Ackde Preventh'on:Chan Ong the "Th3phIgPah It".

We all know there are no simple answers to thechallenge of suicide prevention. However,sometimes opinions about one approach asopposed to another are held with considerableconviction, albeit with little evidence for theireffectiveness.

A concept which may allow us to reconcile andaccept the contribution of opposing views isthat of the "tipping point", first postulated byTittle and Rowe in 1973 and more recentlyapplied to suicidal behaviour (Goldney, 1998).The "tipping point" implies that there is a

background base rate of a phenomenon, whichresults from many factors, and that there is athreshold or "tipping point" which oncebreached allows for a dramatic increase in thephenomenon. It has been used in othercontexts, for example to explain variations incrime rates where there have been markedchanges over relatively short periods of time,such as the dramatic decrease in crime in NewYork City in recent years. Quite clearly thereis no simple answer to this change: it must bethe result of a number of factors which havetipped the balance towards a safer society.

Drawing an analogy with the increase in youngmale suicide in Australia, the, question can beposed: could relatively minor changes in somesociological factors suddenly result in abreaching of the "tipping point" for suicide,with a resultant dramatic increase? Forexample, have there been changes in how oursociety views and rewards young males? Havethere been changes in early parenting practicestowards males? Have ihere been changes insocietal attitudes to the acceptability ofrecreational drug use? Have there been changesin the delivery of health care to young males?Has there been a change in the perceivedwillingness of our society to accept and treatyoung males with emotional problems by theclosure of places of "asylum", i.e. de-

institutionalisation? Have there been societal

changes in regard to the acceptability ofeuthanasia? Has there been undue publicityabout suicidal behaviour?

The answer to each of these questions, andothers which could also be posed, is probablyyes, but no one factor could reasonably beconsidered sufficient to have produced theincrease in young male suicides. Therefore itappears useful to invoke a concept such as the"tipping point" to assist our understanding ofthis worrying phenomenon.

It is important to note that the "tipping point"is consistent with the public health model thatfocusing on so-called high riskpreventive/treatment strategies may not be themost effective way of tackling a communityproblem such as suicide. Thus, when there ismass exposure to risk, as is the case with thewell established but unfortunately non-specificrisk factors for suicide, even if there is only alow level of risk there is an opportunity forbroader measures of control to exert aninfluence. For example, a small shift in one ofthe contributing sociological factors to suicide,a shift which just influences the "tippingpoint" to such behaviour in a large population,may have a far more wide-reaching effect onoverall suicide rates than a more specificintervention aimed, for example, at treatingthose afflicted with depression or substanceabuse. This is consistent with the publichealth "prevention paradox" that "a preventivemeasure that brings large benefits to thecommunity offers little to each participatingindividual" (Rose, 1992).

Possible broad population early interventionswhich could change the "tipping point" awayfrom suicide would include addressing thepreviously noted issues which could influenceyoung male suicide, such as providing aclimate where "time out" or "asylum" wasreadily available and not seen as inappropriate'-in a sense countering the de-institutionalisationat all costs thrust observed in some Such issuesare controversial, as are suggestions for theneed for individuals to develop more resilientand personally responsible coping patterns,rather than attributing difficulties to externalevents. Another possibility could be to changethe perception of suicidal behaviour from the

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"cry for help", with the expectation of assistance, to a "cry ofpain", which is a more accurate description of those who aresuffering and feel driven to suicidal behaviour, but whichdenotes suffering rather than the expectation of care. This hasbeen well described by Mark Williams (1997) in his bookappropriately titled "The Cry of Pain".

It must be emphasised that the "tipping point" concept isdrawn not to denigrate individual treatment programs, asclearly they must ,continue to reduce the personal morbidityand mortality associated with suicidal behaviour. Rather, it israised to illustrate how sociological factors may have asignificant impact on rates of suicide in a given society byinfluencing many persons, albeit in an almost imperceptibleindividual manner.

The "tipping point" may seem too vague and lacking inspecificity by some to be useful. However, in terms of earlyintervention, particularly from the broad public healthperspective, it is worthy of the closest consideration in ourattempts to integrate and accept the importance of differentapproaches to one of Australia's major health and socialchallenges, that of suicide, particularly in young males.

ReferencesGoldney, R.D. (1998). Variation in suicide rates: the

"Tipping Point", Crisis, 19/3:136-138.Rose, G. (1992). The strategy of preventive medicine.

Oxford University Press, Oxford.Tittle, C.R., Rowe, A.R. (1973). Moral appeal, sanction

threat and deviance; an experimental test. SocialProblems, 20: 488-498.

Williams, M. (1997). The cry of pain, Penguin Books,London.

Robert Goldney M.D. is Professor of Psychiatry at theUniversity of Adelaide and Medical Director of The AdelaideClinic. He is currently President of the InternationalAssociation for Suicide Prevention.

Guesg EdigorialaWr Shane Merrigghidgenous Flean and EarDy

Aerar.ng .5,neAchnoMedging the DnfOuences ofthe Past.

I arn of Aboriginal descent from the Kamilaroi People ofNorthern New South Wales. Currently I am a UniversityLecturer, and the Bachelor of Health Science Co-ordinator(Aboriginal Health & Community Development) atYooroang Garang: School of Indigenous Health Studies, TheUniversity of Sydney. My areas of specialty are psychologyand mental health. I am a member of the Consultative

Group for AusEinet, representing NSW and indigenouspeoples. In addition, I am on the Steering Committee for theupcoming AusEinet conference, "Risk, Resilience &Results".

The area of indigenous health is of concern. Obviously, thereis no simple answer to these health problems, as they aitboth multi-layered and extremely complex. I will not be sobold as to pretend I will offer the answer to these concernswithin this editorial. I do, however, hope to outline whyIndigenous Health, and in particular Indigenous MentalHealth, is an issue that has to be addressed.

Early Intervention is a concept that is kept in mind in allteaching at Yooroang Garang. We see education as the key tomaking a difference in Indigenous Health, and we do not see avast difference between other aspects of health, such ascommunity development and primary health care, and

Indigenous Mental Health. Indigenous communities tend tobe holistic, looking at the whole, not only the individualparts. Early intervention thus becomes broader, in a sense,and incorporates prevention, cultural awareness, thestrengthening of culture, self esteem, and the support thatthese factors can give. Early intervention, then, incorporatesaddressing the past, and the recognition of the past for its rolein the problems with health now.

Historically, the Indigenous People of Australia and theTorres Strait Islands have been subjected to displacement fromtheir traditional land. It is very important to understand thatland and spirituality are very closely linked.

The land was declared 'vacant' by the British, thus allowingthe invasion. In order for this to happen, the Indigenes weltthought of, and treated as, sub-human, and as such were to beeradicated or controlled.

This mindset led to a racist base, where to be Indigenous wasto be second class. Socio-economic factors and status keptthe Indigenes in a position where culturally and economicallythey were disadvantaged. This, over the longterm, led tohealth problems to do with hygiene, nutrition and poverty.Death and illness became much more widespread than in thegeneral population.

Psychologically, both the racism and the inequality took theirtoll, especially in the long term. Self-esteem, and

surrounding issues, became associated with substance abuse,suicide, hopelessness, and depression, while broader healthissues added to this anxiety and stress. This, in turn, furtherimpacted upon the feelings of dispossession, bereavement andloss. These issues included the loss of culture, land,spirituality, and more immediate losses, such as the loss ofloved ones, due to morbidity and mortality.

A psychiatrist, John Cawte studied Aboriginal responses towhat he described as the "catastrophic upsets caused byWestern influence" (Cawte, J. 1974, xiv, as cited in Saggers,

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S. & Gray, D., 1991). Cawte investigated "how individualbehaviour is determined by the social and physicalenvironment, and in turn how the disturbed behaviour of anindividual may have an adverse reflexive effect upon the groupin which he lives" (Cawte, J., 1974, xvii ibid). Cawte sawthree main causes of high levels of mental illness among theIndigenes:

I. Problems associated with one culture needing to adaptinto a more technological society.

2. Oppression and exclusion resulting from the colonisationprocess.

3. Exclusion from opportunity (including geographicisolation).

In Cawte's studies he found stress often resulted in mentalillness. He considered that the behaviour of those mentallyill contributed to a breakdown in social cohesion, as didtension-reducing devices like alcoholism and addictions.Saggers & Gray (1991) took this further to agree withCawte's assertion that there is an unacceptable rate of mentalillness in the Indigenous Population, and that the high levelsof mental illness were "one of the injuries suffered by them asa consequence of their exclusion from the wider society andtheir lack of an economic base" (p 11).

Historical influences, society and culture, stereotypes, power,and personal history all combine to influence the individual.Indigenes have, in the last 211 years been subjected to variousinfluences, and these experiences have had their impact on anumber of levels. The recognition of the factors thataccumulate to bring stress and other psychological problemsis critical. Accumulated stress can lead to psychologicalproblems, which in turn can manifest in physical maladies,and vice versa. The effects of this history can be current,handed down transgenerationally.

An understanding of the issues surrounding IndigenousHealth, Indigenous Culture and Spirituality, is important forthe future of health provisions. Indigenous autonomy andinput into decisions affecting Indigenes is also vital.

In order to address these issues, it is important to consider theinfluences of the past, and the manifestations of theseinfluences today, and in the future. The courses at YooroangGarang: School of Indigenous Health Studies aim to give abroad overview of the issues involved in Indigenous Health.We provide expertise in primary health care, healthpromotion, management, community development, research,counselling and Indigenous Mental Health. Our ethos is tofacilitate positive change in Indigenous Health. We areperfectly placed to make a big difference. Most of our studiesare undertaken in block mode. Our students are usuallymature, mostly Indigenous, and probably already working inthe health field in their respective communities. YooroangGarang has the chance to facilitate positive change in a

number of different Indigenous Communities. Our subjects

are based on holism: we strive for empowerment throughculturally appropriate delivery of the subject streams.

Early intervention in mental health aims to 'intervene' at atime when a possible problem might be stopped orminimised and can consider the social, emotional, cultural andspiritual. We can attempt to address the influences of thepast, and try to resolve these, and the associated stressors thatcan have an impact on mental health. We can aim tostrengthen community, culture, self-esteem and support. Wecan look at the whole picture. We can help our studentsunderstand these issues, and hopefully they will modify theconcepts for use in their own communities. I consider this tobe a valid form of early intervention.

ReferenceSaggers, S, & Gray, D (1991) Aboriginal Health & Society.Allen & Unwin. Sydney.For further information, contact Shane Merritt at YooroangGamng: School of Indigenous Health Studies, University ofSydney, PO Box 170, Lidcombe, NSW, 1825. ph. 02 9351

9201, Fax 02 9351 9400, email: [email protected]

Guesg EdigoriallSitephen NllaVheyEar/y DntarvenUon and Riaftea0MenW Fleath

Intervention and Home VisitsConsiderable efforts are being made to provide the bestpossible start to a family's life by intervening early wherethere is risk of the mother experiencing significant distress inthe perinatal period. Early on, work focused on detectingmothers with anxiety or depression and providing a homevisiting intervention. Barnett and Parker (1985) demonstratedthe effectiveness of a year-long support program on anxiousmothers' distress levels using professional or lay people to dohome visits (professionals resulted in superior improvementover lay people). Holden et al., (1989) also provided depressedwomen with a home visitation service over 13 weeks, anddemonstrated that non-directive counselling was effective inalleviating their distress. This study has been replicated byWickberg & Hwang (1996), with similar encouraging results.

Both of these programs illustrate that not only can suchinterventions be effective but that, by offering such assistanceto women who are experiencing difficulty in the earlypostpartum weeks, many accept such help. However, it wouldbe a mistake to think that simply sending people to visitwomen with postpartum depression or anxiety (PNDD) willsolve their difficulties. All three studies had extensive trainingfor the home visitors, both prior to the commencement of theprograms, and with ongoing supervision. Simply sendingvisitors to a new mother is not sufficient if we are to make an

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impact on her, and the family's, psychosocial adjustment.For many years all new parents have had a Health Visitor inBritain, with visits lasting up to a year. However, even withthis service the rate of maternal depression in British studieswas never lower than in countries where the new mother didnot receive such home visiting. Thus careful considerationmust be given to the aims of the visit, the skill of thevisitor, the model of intervention to be provided, and thetraining and back-up support that is given. Indeed, FamiliesFirst, a program commencing in New South Wales in thenear future, which aims to visit all new parents, augurs wellfor families providing that these issues are adequatelyaddressed. It is all too easy to assume that programs whichprovide 'home visiting' must be beneficial but as with anyintervention, the content and process issues must be routinelymonitored and adjusted if we are to ensure that what looksgood on paper is actually good in practice, and demonstratedto be so (or not) by proper evaluation.

The success of such programs, together with the increasedacknowledgment of the extent of difficulties faced by newparents, has lead to the recommendation in NSW that all newmothers be given the Edinburgh Postnatal Depression Scaleat their initial visits to the Early Childhood Clinics (PNDServices Review, 1994). This is a self-report instrument usedas a screen, and sensitive for postnatal depression, which isbrief and has high acceptability to the women. Thus the moveis towards the health services taking a proactive role indetecting women with PNDD.

Screening PredictionThere is also now a move towards attempting to predictwhich parents will become depressed or anxious, and therebyeither provide them with a service in their pregnancy, orprovide extra support, if needed, in the early postpartumweeks. Initiatives in this area include those by Appleby et al(1994), Beck (1995), Cooper et al., (1996), and more locallyby ourselves and colleagues in South West Sydney ('MINET'project) and also in South East Sydney.

The benefits of trying to predict who will become depressedare in one sense obvious. If we are 'correct' in ourpredictions, then considerable effort and expense can be sparedby knowing who to target once the baby is born. Informationcan be transferred to Early Childhood services so that at amother's (or father's / couples') first few visits with the baby,sensitive inquiring about how she is managing can be

undertaken with the knowledge of the risk factors identified inher pregnancy (such as lack of support or feeling depressed).Appropriate intervention can then be offered, and the family'sadjustment can be monitored, so as to maximise theopportunity for a good beginning for the family.

But what if we are not 'correct' in our predictions? To datethese studies, utilising many risk factors for PNDD, have notshown high accuracy in predicting antenatally those womenwho will develop PNDD. A consideration of some factorscould provide an explanation for this low hit rate.

Around half of women with PNDD have experienceddepression either during their pregnancy, or have had a historyof depression in their life. Whether screening measures, suchas those discussed above, will have differential accuracy atpredicting these two categories of PNDD, known as

'Recurrent' or 'De Novo' (Cooper & Murray, 1995), is yet tobe tested. It may be that if studies determine the accuracy ofprediction instruments for each of these two groups, then thesuccess rate of the instrument (adjudged by its receiveroperating characteristics) may be found to be good for at leastone of them.

Another consideration is whether different stressors associatedwith PNDD are more predictive than others. Thus while it iseasy to read the research into risk factors, build up a picture ofwhat seems to 'cause' PNDD (which should more correctly beread as being 'associated' with), and conclude, for example,that complications in delivery will not 'result' in PNDD (asthe majority of studies show little association between thisand PNDD), such an interpretation is clearly incorrect whenone moves from the overall descriptive statistics ofquantitative research, to the individual stories of womenthemselves. Thus for most women, having a caesarean willnot be associated with feeling depressed. However, but thereare instances where having a natural birth is valued so highlyby a woman that not having this, in conjunction with otherfactors, will result in a high level of postpartum distress.Because of these idiosyncrasies in human behaviour andemotions, screening based upon a simple presence/absence ofcertain risk factors cannot be expected to be 100% accurate.The prediction formula may well have to be considerablymore sophisticated than a simple algorithm which sumsdifferent risk factors. It may need to weight different stressors,or combinations of stressors, if it is to be useful. But if suchpredictive instruments remain poor in predictive power,should such screening be abandoned, at least in the antenatalperiod?

The argument for screening antenatally or postnatally if wecan't develop a highly predictive instrument is, I would argue,strong. We are not just interested in the woman's wellbeingafter the birth. Antenatal care is just that care for all aspectsof the woman's health during the antenatal period. Screeningtherefore has the dual purpose of predicting and providing aclinical service at the same time. Asking not just aboutpossible risk factors, but also about how she is feeling now,will be of enormous benefit for her and her family. A womanwho is struggling emotionally during her pregnancy needssupport, in whatever form, at this point. By providing thissome mothers may adjust better, and better utilise servicesand supports before and after the birth - thereby reducing theaccuracy of our predictions in the best possible way.

There are also other benefits to such early screening. Byinquiring of all mothers in their pregnancy on such issues aslikely support after the birth, whether or not there has been ahistory of anxiety or depressive conditions previously, and



current mood and feelings towards the pregnancy, we areshowing that we care about not just the infant, nor just abouther physical wellbeing, but also about a mother'spsychosocial adjustment to her situation. There are a

significant number of women who experience postnataldepression without any of the risk factors during theirpregnancy. For these women, similar follow-up questions atthe Early Childhood Clinic will remind the mother of ourinterest in her wellbeing. It is possible that this will result inthese `de novo' depressed or anxious women being morewilling to seek appropriate support at this time.

Another consideration, if our screening instruments are notparticularly successful at prediction, are those women who arepredicted as being of low risk of becoming postnatallydepressed. The temptation would be not to offer these womena screening service in the postnatal period, and to assume thatbecause they were low-risk' in pregnancy they do not needthe resources in comparison to 'high-risk' women. This is arisky strategy. Women's circumstances change - while theremay have been support during the pregnancy with no majorstressors, for a fair number of women other issues will havearisen since the pregnancy that now would put them at risk ofhaving difficulty coping. The birth may not have goneaccording to plan, close relationships may have changed, orother major life events could have occurred. Thus screeningall women postpartum is necessary to ensure such women arequickly detected and offered help if required.

Of course, and this is a personal (and I'm sure some wouldsay male!) view, if the screening is used to subtly make awoman feel guilty if she has any thoughts of notbreastfeeding then it will have the effect of driving womenaway from health services. I have spent the last three yearsinterviewing many new mothers and fathers, and understandthe effects of the hospital 'baby friendly' policy on some ofthese parents. The stress that they report at the inability ofhealth services to respect their informed decision to bottle feedis substantial. As one father said to me, having expressed hisanger at the intolerance of many staff at their decision not tobreastfeed: "Are we actually allowed to bottle feed ourbaby?".

Ilntervenfions for 'at-risk' womenThis move towards identifying high-risk women in the

antenatal period has lead to studies examining theeffectiveness of providing support to those considered to be'at-risk' in their pregnancy. Several investigators haveexamined the efficacy of running groups or individualcounselling at this time, and sometimes extending these tocontinue into the postpartum period (e.g., Elliott et al, 1988;Stamp et al, 1995). Some studies show benefits, while othersdo not. Of interest in such work in one sense is theassumption that one intervention should be effective for allat-risk women. Undoubtedly we shall soon move in thedirection of attempting to compare different earlyinterventions for different types of women - whether the typesdiffer in their risk factors, or in their personality or coping

styles, are just, some of the considerations that may beworthwhile to pursue. For some women, interventions thatprovide non-directive support may be most beneficial while,for others, practical ways that increase the sense ofcompetence at caring for an infant may be more appropriate.Our own research (Matthey et al., in preparation) in providinginterventions antenatally to couples suggests that a woman'sself-esteem is an important variable that plays a part in howeffective certain interventions are in the antenatal period, andthis finding ties in well with the evidence of the role of self-esteem in the aetiology of depression (cf. Brown et al., 1990).Another consideration, which is again being explored in ourresearch, is the role of the woman's partner. It is likely thatinterventions will differ in their effectiveness (for both thewoman and man) depending upon the quality of the couple'srelationship. Thus when and how to include the partner inantenatal or postnatal interventions, or screening interviews,needs to be empirically determined. Up to now suchconsiderations appear to be based more upon practicalconsiderations than well-supported theory.

ConclusionsIn the next few years I expect, that we shall see continuedadvances in the use of screening instruments antenatally andpostnatally for women, and an advance in our thinking of theoverall benefits of such screening. Research is likely toinform us further as to the matching of interventions todifferent types of difficulties or aspects of the parents in theperinatal period. Increasingly the role of men in all of theseaspects will be explored.

ReferencesAppleby, L., Gregoire, A., Platz, C., et al. (1994). Screening

women for high risk of postnatal depression. Journal ofPsychosomatic Research, 38, 539-545.

Barnett, B. & Parker, G. (1985). Professional and non-professional intervention for highly anxious primiparousmothers. British Journal of Psychiatry, 146, 287-293.

Beck, C. T. (1995). Screening methods for postpartumdepression. Journal of Obstetric, Gynaecological and

Neonatal Nursing. 24, 308-312.Brown., G. W., Bifulco, A., Veiel, H. 0. F. et al. (1990).

Self-esteem and depression. Social Psychiatry and

Psychiatric Epidemiology, 25, 225-234.Cooper, P.J. & Murray, L. (1995) Course and recurrence of

postnatal depression: Evidence for the specificity of thediagnostic concepts. British Journal of Psychiatry 166,191-195.

Cooper, P. J., Murray, L., Hooper, R., & West, A. (1996).The development and validation of a predictive index forpostpartum depression. Psychological Medicine, 26, 627-634.

Elliott, S. A., Sanjack, M., & Leverton, T. J. (1988).Parenting groups in pregnancy: a preventive interventionfor postnatal depression? In B. H. Gottlieb (Ed.),Marshalling Social Support. pp 87-110. Newbury Park:Sage.

Funded under.the National Mental Health Strategy by the Commonwealth Department of Health and Family Services(-1

IbbN 1SLU-73/LIJ liflarCn, 1VVU ra e o

Holden, J. M., Sagovsky, R., & Cox, J. L. (1989).Counselling in a general practice setting: controlled studyof health visitor intervention in treatment of postnataldepression. British Medical Journal, 298, 223-226.

Postnatal Depression Services Review (1994). NSW HealthDepartment. State Health Publication No. (PA) 94-131.

Stamp, G. E., Williams, A. S., & Crowther, C. A. (1995).Evaluation of antenatal and postnatal support to overcomepostnatal depression: a randomised, controlled trial. Birth,22, 138-143.

Wickberg, B. & Hwang, C. P. (1996). Counselling ofpostnatal depression: a controlled study on a populationbased Swedish sample. Journal of Affective Disorders, 39,209-216.

For further information contact Stephen Matthey, SeniorClinical Psychologist & Research Director, South WesternSydney Area Health Service, Park House (Paediatric MentalHealth Service), 13 Elizabeth Street, Liverpool 2170.ph; . (02) 9827 8011; fax: (02) 9827 8010; email:[email protected]

EVALUATION OF FIRST NATIONALSTOCKTAKE REPORT OF EARLYINTEr ENTION PROGRAMS

First Report of the National StocktakeThe First Report of the National Stocktake of EarlyIntervention Programs was completed in July 1998 withprinting and dissemination (to 2500 people) taking a further 6weeks. In order to obtain feedback on this report and to assistin the development of the Second Stocktake Report, anevaluation form was included in each Stocktake Report.Findings from those completed, and returned to AusEinet, aresummarised.

The response to the First Report has been overwhelminglypositive. . Fifty four (54) completed evaluation forms werereceived. In addition, AusEinet project staff received anuMber of favourable phone calls. A further 135 copies of theStocktake have been disseminated following requests frominterested individuals and organisations.

As can be observed in the summary below, the feedbackreceived on the First National Stocktake Report of EarlyIntervention Programs was overwhelmingly positive

1. Overall response to the report (n=54)50 positive responses were received. A number ofrespondents commented that the report was an 'excellentiesource', was 'informative and easy to read', 'comprehensiveand clear' and provided a useful 'snapshot of services'. Thereport was also considered to be a valuable tool in that itdemonstrated a range of approaches, and the theoretical basesunderlying them. One new service commented that 'as aservice just setting out, (the report) has been invaluable in

Ibppe

regard to networking, information gathering and gaininginsights into how others solve the problems faced.' Thedivision of programs into different prevention orientationlevels was seen as a positive attribute of the report as werethe chronological frameworks and indexes.

One criticism of the report was that it was difficult toascertain credibility and how effective programs are. (It

should be noted, however, that the stocktake report was notable to assess 'effectiveness' of the early interventionprograms reported on due to lack of evaluation data reportedby the programs themselves).

Most respondents reported finding the report easy tounderstand, well presented and very relevant to their workcontext. Several respondents were critical of the layout of thereport. Responses varied in terms of whether the ideas

presented in the report would change their way of working.

2. Strengths off the reportStrengths of the report identified by respondents included thestandardised format used in the report, the use of graphs, thecomprehensive details of programs provided and themultifaceted approach employed. The report's potential fordissemination of information and networking across agencieswere also highlighted. Other comments included:

I like the size of the book, easy to handle; also nice tofeel, clear print and headings.An excellent inventory of programs and projects; enoughinformation to make a decision about contacting specificpeople about these programs and projects

3. Omissions or limitations off the reportA number of early intervention programs, were identified asnot included in the report. This was in part because manyprograms had not completed stocktake forms. However,where possible, information on these programs will be

included in the second report.

It was suggested that some type of 'evaluative hurdle' wasneeded to allow programs to be included. However, given thedifficulties involved in evaluating early interventionprograms, AusEinet project staff believe it is preferable toallow programs to decide whether or not to includethemselves in the stocktake. Another respondent commentedthat it was unfortunate that information on some programswas incomplete. Again, it should be noted that the projectteam was, (and is) reliant on the information provided to themby programs. It was also pointed out that like any stocktake,the information presented in the report requires continualupdating.

4. Suggested possible inclusions in subsequentreportA range of suggestions were received for possible inclusionsof information in subsequent stocktake reports. Theseincluded:


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A clear identification of regions, services which needtargeting for programsOther services for survivors of torture and trauma servicesin NSW, VIC, QLD, SA and TASSome necessity foragencies to show evidence for successand have these separated from other programs reportedThe impact the report would have on funding resourcesto gain more funds for more programs and rural sector ofAustralia misses outFees charged; planned program modifications; an inclusionin the chapter introductions outlining current service gapsActive search for programs aimed at integrating at riskgroups into the workplacePerhaps define "risk" a bit more.Reply-paid envelopes for feedbackPerhaps a national rating scaleA section on rural early intervention projects and theproblems they faceBook is too heavy not easily transportedMore information on indigenous programs. A separatestrategy and report required to do this justice. Someexcellent preventive initiatives are under way but are notin this report. Phone interviews with OATSIHS andNACCSCO in first instance would be a good start(sending questionnaires may not be appropriate)

5. Possible beneficiaries of the reportA range of potential beneficiaries of the report were identified.These included:

Any people involved in the mental health area for the 0-25year olds (and others who need a referral/contact reference).All major community mental health agencies should havea copy. (mental/health and illness, communityinformation centres, education regional offices, probably anumber of psychiatrists and psychologists would also begrateful).All medical therapeutic educational and welfare personnelwho have contact with young people on a regular basisChildren and young people, all who work in the fieldParents/ teachers/ psychologists/ social workers/ nurses,general practitionersPractitioners in mental health, consumer groups, educatorsin mental healthProgram managers and policy bodies, school/youth/theatregroups or church groups working to help better lifestylechoices, harm minimisation, etc. and to encourage betterawareness of services in region, funding bodies to map outgaps in services.Community child health units, community health centres,child and adolescent mental health units, schools,community centresService providers, consumer groups, information servicesProgram evaluators, child and adolescent workersAll those concerned with youth suicide and othersEverybody who works, lives with, or is a young person."I'd like to see a state by state 'friendly' booklet ofprograms given to young people so they are not left in thedark."

Anybody who works with young people and young peoplethemselvesPeople trying to initiate new programsObviously anyone working in early intervention programs(professionals) and those persons. hoping to get localprograms up and running (community workers,volunteers) and those clients who benefit from theassistance of such programs and workers.Service providers, familiesHopefully those people at risk of becoming marginalisedand consequently hindered in their development. Smallerservices who don't have the resources to design programs.Referring agencies, health professionals, school staff,young people/families (possibly), researchersAgencies investigating early intervention strategiesAll CAMHS; consumer peak bodies; state mental healthadmin istrations

Other commentsA number of other comments were made by respondentswhich covered a range of areas including layout of the report,the need for regular updating of information and

congratulatory information. More specific comments relatedto the perceived need (by one respondent) to take into accountreligious, moral and ethical teachings. The AusEinet projectstaff has carefully noted all comments and will make changesas appropriate in the Second Report.

Second Report of the National StocktakeOver 2000 questionnaires have been distributed to obtaininformation for the Second Stocktake Report. It is currentlyanticipated that the report will be printed and disseminated inApril 1999. Feedback from the First Report has been notedand as a consequence, some minor changes will be made tothe layout of the Second Report and a glossary will beincluded. The indexing will also be improved.For further information contact Ms Cathy Davis, AusEineton telephone 08 8357 5788, facsimile 08 8357 5484 ofemail: [email protected]

G-Tio the Depths and Back

This is the title of the opening, during Mental Health Weekin Canada, May 3-7th 99, of the Artist's Loft in Sudbury,Ontario, Canada, to which I have been invited to bring my artwork. One of my pieces was called 'Into the Depths', a placemost of we bipolar sufferers have been. I was not diagnosedas bipolar 2 till May 1998, at the age of 61. Unaware of thepresence of this syndrome affecting me, I had managed 'toaccumulate B.Agr.Sc., M.Sc., Ph.D at Harvard, entry toHarvard's Society of Fellows as the first Australian ever sohonoured, a D.Sc. from Monash, 70 re§earch papers, 3 books,and had worn out two good women over 34 years in the

process. I had also driven many, but by no means all, of mycolleagues, to distraction, and some of them had in turn made



sure I would never make Professor by blocking a promotionthat should have been automatic.

I was a troublemaker. I said it as I saw it. Worse, I wasoften correct, but blunt forthrightness is not all that wellliked in Academia Australiensis, though it was the stuff oflife in Harvard, my second alma mater.

Six serious depressive episodes punctuated that career, alltriggered by serious, but common, life path emotionalchallenges (divorces, infidelities, abortions - the usual stuft).Hypomanics who don't know they are hypomanics stressthemselves with overwork, and the manic depression does therest when the next serious challenge arises to ones emotionalstability.

My first escape from depression was "aided" by nortryptyline;I got better rapidly because it made me feel so lousy I wantedto escape from it! Later depression episodes lasted longer, andthe fourth one I seriously contemplated suicide; it lasted 12months. The last one was prompted by my sister muttering"manic depression". I managed to get a referral to apsychiatrist in the middle of it and he diagnosed bipolar 2(manic/depression type 2) in 30 minutes. Helped out ofdepression by Zoloft (great for your sex life!), I have been offall medications for more than 2 months.

I use self-discipline to control the hypomania (no more thanfive active projects at once, absolutely rigorously enforced),days off whenever I feel tired, sleep whenever I need it for aslong as I .need it (embarrassing but necessary in boringmeetings, or at dinner parties, the opera etc., since I alsosnore!) and so far so good. My work at,a PsychoaestheticsGroup meeting each week also helps dramatically, as does mymarvellous, superbly permanently hypomanic, totallydedicated psychiatrist, who might not want me to name himjust at this moment!

For further information contact Dr Teri O'Brien, D.Sc.,F.A.I.Biol. Former Reader in Botany, Monash UniversityHonorary Research Fellow, La robe University VisitingResearch Fellow, University of Hong Kong

Consumer nvobeement

A particular challenge of the AusEinet project and of course,of all services providing direct or indirect treatment andintervention to children and young people is that offacilitating meaningful consumer participation. Indeed, theNational Mental Health Policy and Plan specified consumerrights as one of the 12 policy areas for reform under thestrategy, as well as defining specific objectives and strategiesfor implementation. Significantly, the recently released

report of National Stakeholders Consultations contained inthe Evaluation of the National Mental Health Strategy

(Manderscheid and Pirkis 1997) stated that consumerempowerment was considered to have improved substantiallyunder the Strategy, particularly at a national (and to a slightlylesser extent, State/Territory) level. Consumer involvementon bodies such as NCAG were applauded as were

opportunities for networking and information-sharing at

venues such as the THEMHS Conference (ibid, page 5). Itwas notable, however, that the 'trickle down' effect to thelocal level was 'still patchy, with many consumers stillfeeling disempowered, for example, when it came toinfluencing their own treatment' (ibid, page 5). The Strategywas felt to have achieved less with regard to the rights ofcarers.

In attempting to explore how to encourage 'meaningful'consumer participation in the AusEinet project, the projecthave examined the following questions:

why is consumer involvement needed?what is 'meaningful' consumer involvement?what strategies facilitate meaningful/effective consumerinvolvement?How can the needs of both consumers (young people) andcarers be represented?

We are still grappling with these questions. Some of ourthoughts appear here and we welcome your comments andsuggestions.

Why consumer involvement? - the importance o fffinding a voice

Finding a voice means that you get your own feelinginto your own words and that your words have the feelof you about them (Seamus Heaney 1980:17).

One of the major changes occurring in human serviceagencies in general is a long overdue shift away from adisproportionate focus on service providers to clients/consumers of services. Effective consumer feedback systemshave long been seen as providing benefits to the businesssector by means of customer satisfaction surveys (Hirschman1970). More recently, however, it has been postulated thateffective client/customer feedback systems can providebenefits to managers and clients of human service programsincluding mental health services. Unfortunately, however,national policy does not state how this is to be supported andencouraged at the local level. Client/consumer participationcan be part of strategic planning; service planning; policydevelopment; service delivery; quality management; and

review and evaluation (Donabedian 1992). Additionally,writers such as Draper (1997) and Jones and May (1992) haveasserted that consumer participation can enable betterfunctioning of human service teams and create more openculture in agencies whereby consumers/ clients become alliesin service delivery.


os.

ISSN 1.329-6726" March, 1999 Page 9 Issue 8 - 1/99

The move towards the development of client / consumerfeedback systems in human service agencies has not beenwithout criticism. Some writers have questioned whether theconcept of 'consumer satisfaction' which comes from thebusiness sector can be applied to the non profit social servicesector, given the differing perspectives and backgrounds ofpeople in these systems. Particular difficulties in relation togiving clients/consumers 'a voice' have also been raised. It

has been suggested that the uneven power relationshipexisting between human service workers and clients will giverise to problems in staff collecting data (Wilhite and Sheldon1997). Moreover, it has been suggested that clients whoreceive human services such as child protection services ormental health services are often unlikely to be seen as criticalof service providers and experience difficulty in bringing intolanguage a critique of existing services (Ringma and Brown1991).

Despite these challenges, it is argued that clients of humanservice agencies such as mental health services need to begiven a 'voice'. The rationale for this comes from a range oftheoretical frameworks which have an ethical, rights-based orconsequentialist basis:

The ethical framework stresses the concept of clientautonomy and self determination. Consumer researchcontinually elicits from consumers the comment that theywant to be 'treated with respect, like a person' (Entwhistle1997:426).The rights-based approach incorporates the notion thatclients/consumers have rights, for example, toinformation, choice, safety, fair treatment and redressThe consequentialist approach judges the rightness of theapproach from the point of view of the consequences.This approach underpins the attempts to provide evidence,based on research, that outcomes are improved bydeveloping partnerships with clients/consumers or services

What is consumer involvement?The concept of consumer involvement or consumerparticipation embraces a number of areas includingparticipation at the individual level, policy, planning anddecision making processes as well as service delivery levels.

Considerable work has been undertaken on the development ofclient feedback mechanisms and other mechanisms to giveclients 'a voice' in the health and mental health systems.(See for instance Draper 1997 and National Mental HealthPlan 1998). Despite this, however, actual operationalisationof this still has a long way to go. A recent discussionconcerning consumer involvement on the EINET emaildiscussion list noted that while national policies state thatconsumer participation in services is a 'must', policies lackinformation on how this is to be supported and encouraged atthe local level.

Particular questions which have been aired on the EINET siteare as follows:

What is 'meaningful' consumer representation?What strategies can be employed to encourage consumerparticipation?Who determines who should represent whom?How do you ensure the representativeness of consumers?How do you support and encourage consumers at the locallevel?

What strategies facilitate meaningful/effectiveconsumer involvement?An interesting paper on consumer and carer involvementpresented at the 1997 THEMHS conference by Sozemenou etal (1997) highlighted some of the facilitators of and barriersto participation."

Consumers Carers Staff/Management

Resources Resources Structure and process

Supportivegroup facilitator

Supportiveenvironment

Knowledge and skills ofconsumers

Widersupportiveenvironment

Knowledge andskills

Support and resources

Knowledge andskills ofconsumers

Structure andforms

Attitudes, commitmentand responsivity of staff

Attitudes andcharacteristics ofconsumers

Attitudes ofcarers

Responsibility on thepart of consumers

Issues specificto NESB

Issues specificto NESB

Issues specific toculture and ethnicity

Table 1: Facilitators of and barriers to participation(Source: Sozomenou et al., 1997). Weavingpartnerships: bringing together the threads of consumer andcarer involvement

diverse

A lack of space in this issue precludes further discussion ofstrategies identified from the literature. However furtherdiscussion of consumer involvement will appear in June'sissue of AusEinetter. Your suggestions and contributionswould be ',velcomed!

ReferencesManderscheid, R.W., Pirkis, J. (1997). Evaluation of the

National Mental Health Strategy. Canberra:. AGPS.Donabedian, A. (1992). 'Quality assurance in health care:

consumers' role'. Quality in Health Care. i :4, pages 247-251.

Draper, M. (1997). Involving consumers in improvinghospital care: lessons from Australian hospitals. HealthServices Outcomes Branch: Commonwealth of Australia.

Entwhistle, V. et al (1997). 'Supporting consumerinvolvement in decision making: what constitutes qualityin consumer information?' International Journal for

Quality in Health Care. 8:5, pages 425-437.


ISSN 1329-8720 March, 1999 Page 10 Iisue 8 - 1/99

Heaney, S. (1980). Preoccupations. London: Faber and Faber.Hirschman, A.O. (1970) Exist, voice and loyalty: responses

to decline in firms, organisations and states. Cambridge,Massachusetts: Harvard University Press.

Jones, A. & May, J. (1992). Working in human serviceorganisations. Longman: London.

Ringma, C. & Brown, C. (1991). Hermaneutics and thesocial sciences: an evaluation of the function ofhermaneutics in a consumer disability study. Journal ofSociology and Social Welfare. 18:3, pages 57-73.

Sozemenou, A., Mitchell, P., Fitzgerald, H.H., Malak, A. &Si lova, D. (1997). Weaving diverse partnerships: briningtogether the threads of consumer and carer involvement.Proceedings of the 7th Mental Health Services ConferenceInc of Australia & New Zealand (THEMHS).

Wilhite, B. & Sheldon, K. (1997). Consumer satisfaction forindividuals with developmental disabilities. Activities,Adaptation and Aging. 21:3, pages 71-77.

For further information contact Ms Cathy Davis, SeniorProject Officer, AusEinet, ph. 08 8357 5788, fax 08 83575484, email: [email protected]

MENTAL HEALTH CONSUMERPARTnPATOON N A CULTURALLYDMERSE SOCOETY

The Transcultural Mental Health Centre of NSW hascompleted a national research project examining innovativestrategies that have successfully involved consumers andcarers in partnership in mental health service development andevaluation. The project was funded by the AustralianTranscultural Mental Health Network under the Mental HealthStrategy.

Mental health and health services often find it difficult toinvolve consumers, carers and communities frommarginalised groups in society in partnership in thedevelopment, management and evaluation of services. Amajor objective of the research was to identify factors that arecritical to success in engaging disadvantaged and marginalisedgroups such as individuals from linguistically and culturallydiverse backgrounds, women, the elderly and young people.

Original data collection involved three components:(i) a national survey examining consumer and carer

participation strategies(ii) in-depth case studies of innovative initiatives within

8 organisations/services(iii) a broad consultation with consumers, carers and

community members

On the basis of the findings of the national survey, eight (8)initiatives judged to be best practice examples of consumerand carer participation were selected to be studied in-depth.

The eight sites were selected from four different states aroundAustralia and included a variety of community participationinitiatives spanning: national; state; area/regional; localmental health services; non-government organisations; acutein-patient units and employment services.

The findings from the eight organisations which included over80 interviews with consumers, carers and health professionalfocuses on the results relating to four key areas:

definitions of 'partnership' held by staff, management,consumers and carersthe barriers and facilitators to achieving genuine consumerand carer partnerships with people from linguistically andculturally diverse backgrounds; andissues related to consumer and carer representativeness

Suggestions are also made regarding the development ofpartnerships that embrace the social, linguistic and culturaldiversity of consumers and carers, and the need for

participation strategies to be Flexible, Diverse and

Supportive.

The monograph Mental Health Consumer Participationin a Culturally Diverse Society will be available bythe end of March. For more Wormation please contactAndrew Sozomenou at the Transcultural Mental HealthCentre, Cumberland Hospital, Locked Bag 7118,PARRAMATTA BC NSW, phone (02) 9840 3800 or fax(02) 9840 3755.

flSPA (Saackfie Proven Von Austraga)Mat'oonaD ConferenceMellbourrnie: 25th -27" March, 1999

sith

SPA will be hosting a conference on suicide prevention titled"Suicide Over the Lifespan: What Works Across theCountry?" at the Melbourne Convention Centre from the251h-27th March, 1999. Key note speakers include ProfessorIan Webster, Chair, National Advisory Council, NationalYouth Suicide Prevention Straetgy; Dr Annette Beautrais;Professor Robert Goldney; Dr Chris Cantor; Ms KerrynNeu linger; Dr Michael Dudley, Richard Eckersely and WayneSanderson

A range of papers are being presented across themesincluding: professional collaboration; risk factors; indigenoussuicide; rural research; general practice; clinical interventionresearch; resilience; schools, empowering young people;community development; therapeutic story telling; self andsociety, and same sex attraction.

The next issue of AusEinetter will contain a summary ofhighlights from the conference.


ra


Aus [inetThe Australian Early Intervention Network for Mental Health in Young People

CONFERENCE"Re44, Reateeace & Re4att4

to be held at

Adelaide Convention Centre6th 8th June 1999

Expressions of Interest Invited Speakers include:Contact: SAPMEA68 Greenhill RoadPARKSIDE SA 5063Phone 08 8274 6060Fax 08 8274 6000

Professor Mark Fraser (USA)Assoc Prof David Fergusson (NZ)

Professor Beverley RaphaelProfessor Patrick McGorry

Dr Alan RosenDr Ian Shochet

Ms Sharon CruseMr Tim Keogh

Consumer (tba)Dr Anne Sved-Williams

Email [email protected] further information visit the Conference website:http://www.sapmea.asn.au/auseinet.htm

The program committee encourages abstract submissions on early intervention in all its formsas applied to a range of mental health problems, issues and disorders. Papers may be

theoretical in nature, or address practice/clinical management, training, research or policyissues.

13Funded under the National Mental Health Strategy by the Commonwealth Department of Health and Family Services


Abstracts for the conference are still being accepted. Pleasecontact SAPMEA, 68 Greenhill road, Wayville 5034, SouthAustral i a.

EarDy DntervenVon Conference Telephone: +61 8 8274 6060Facsimile: +61 8 8274 6000

The AusEinet hosted international conference on early Email: cony @sapmea.asn.au

intervention titled "Risk, Resilience and Results" promises to Web: www.sapmea.asn.au

be an exciting and innovative event. A range of key note A limited number of funded registration places are available for

speakers will be presenting including: consumers. Please contact Cathy Davis, Senior Project

Professor Mark Fraser of the School of Social Work,University of North Carolina

Officer, AusEinet, Phone 08 8357 5788 for furtherinformation.

Associate Professor David Fergusson from the ChristchurchHealth and Development Study, Christchurch UniversityNew ZealandProfessor Beverley Raphael, Director of the Centre forMental Health, NSW HealthProfessor Patrick McGorry, Centre for Young People'sMental Health, ParkvilleMr Tim Keogh, Director of Psychology & SpecialPrograms, Dept of Juvenile JusticeDr Anne Sved Williams, Helen Mayo House IntegratedServiceDr Alan Rosen, Director of Psychiatry, Royal North ShoreHospitalMs Sharon Cruse, Lecturer, Community Mental Health,Yunggorendi, Flinders University of SADr Ian Shochet, Griffith Early Intervention Program,Griffith UniversityAssociate Professor Graham Martin and Professor RobertKoskey, Joint Project Directors, AusEinet

Professor Fraser's areas of specialisation include the aetiology,prevention and treatment of aggressive behaviour in childhoodand adolescence and services for children and families.. Hispublications include "Risk and resilience in childhood; anecological perspective" (1997); "Evaluating family-basedservices" (1995) .(with Percora, Nelson, McCroskey and

Meezan); Families in crisis: the impact of intensive familypreservation services" (1991) (with Pecora, and Haapala); and"Making choices: social problem-solving for children" (inpress),(with Nash, Galinsky and Darwin). . -

Presentations include:"Early intervention: risk. Resilience and results" (ProfessorBeverley Raphael)"Realistic prevention: youth mental health model"(Professor Patrick McGorry)"Early intervention in young offenders: a second chance"(Mr Tim Keogh)"Early intervention mindset:. system rebuilding for earlyintervention" (Dr Alan Rosen)"The resourceful adolescent program (RAP): a

comprehensive approach to the prevention of adolescentdepression" (Dr Ian Shochet)"Darwin to Adelaide: Out Back or In Front?" (Dr AnneSved-Williams)"Antecedents in contemporary Indigenous Mental Health:What now?"

METHave you subscribed to the AusEinet early intervention emailmailing list? To subscribe, please email maiordomo@

auseinet.flinders.edu.au In the text, write "subscribe einet" inthe mail message body.

AusEinet DatabaseThe AusEinet database is steadily developing. To assist usplease complete the following details and forward to AusEinet ifyou would like to be informed of future AusEinet activities,nationally or in your own State or Territory.Please let us know if we have incorrect addressdetails.

Name:

Organisation:

Address:

P/C

Telephone Facsimile

Email:Return to AusEinet Cl- CAMHS, Flinders Medical Centre,Bedford Park SA 5042. Telephone: 08 8357 5788 Facsimile:08 8357 5484 Email: [email protected]

THE NEXT ISSUE WILL BE PRODUCED IN JUNE. DEADLINE FOR

MATERIAL WILL BE FRIDAY 11TH JUNE 1999. PLEASE LET

US KNOW WHAT YOU ARE DOING. CONTACT AUSEINET WITH

SUGGESTIONS FOR TOPICS TO BE COVERED.

AUSEINET WEBSITE ADDRESS http://auseinet.flinders.edu.au

This issue will incorporate a summary of the AusEinet EarlyIntervention Conference "Risk, Resilience & Results".

(;:-. t.


A

,

ti)

ISSN 1329-8720Issue 9, June 1999 - No 2/99

Guest Editorial

EARLY ONTERVENTDON:FROM RI-IETORDC TO...?

The last three months has seen a lot of activityby the AusEinet project staff. One of the mainactivities, was the staging of the internationalconference on early intervention, Risk,

Resilience and Results at the AdelaideConvention Centre from 6th-8th June. From therange of presentations from both national andinternational speakers, it is clear that earlyintervention is very much on the agenda. Whatis less clear, however, is a consensus view onwhat 'early intervention' actually is when wethink in terms of the mental health of childrenand young people. More work is also neededin terms of identifying specific earlyintervention strategies that are effective in

intervening in the developmental trajectory ofspecific mental health problems, in matchingthese strategies to the characteristics of anindividual and in judging the appropriate timeto implement these stiategies. Essentially then,if we are to move from the rhetoric of earlyintervention, much more research and synthesisof the existing literature is required to addressthe questions:

What works, with whom and when?

AusEinet has been provided with additionalfunding to complete a number of its

deliverables over the next 6 months. Duringthis time, the project staff will be attempting tomove much more from the rhetoric of earlyintervention to its reality that is, there will bean increased focus on addressing how earlyintervention can be practised in relation to themental health of children and young people.This will be evidenced in the completion of theStream II and II activities and in thepublication and dissemination of the SecondReport of the National Stocktake of EarlyIntervention Programs, the literature reViewand a publication designed to assist withtraining in early intervention.Cathy Davis, Senior Project Officer, AusEinet

AUSIENET UPDATE : STREAMSIlli and 1}[11

Stream II: ReorientationThe reorientation placements were completedat the end of May. All the agencies met theiroriginal objectives (several achieved more thanplanned) and all have put sustainable strategiesin place. Over the next month or so I'll beworking on the Orientation AusEikit. This willbe a summary of the objectives and outcomesof each placement, an overview/analysis of theoutcomes from a capacity building perspectiveand a description of the strategies used tomanage the placements. We expect theAusEikit to be ready for distribution in

September or October.The AusEinet team wishes to thank the StreamII mental health workers and their agencysupervisors. They did a terrific job and we'veenjoyed working with them.Stream III: ProjectsAusEinet has funded six projects which willmake a contribution towards the developmentof good practice in early intervention. Severalof the projects are completed and the others arevery close to completion. We'll placesummaries of the projects on the AusEinetwebsite by the end of September. Theresearchers will be encouraged to publish thefull account of their work in scientific journals.Stream III: GuidelinesAusEinet has commissioned guidelines 'for

early intervention in ADHD, anxiety, chronicconditions, conduct disorder, delinquency anddepression. Work is still in progress, thoughseveral are very close to completion. Weexpect to make the guidelines available inOctober. Keep an eye on our website for moreinformation closer to that time.

For further information on Stream II and IIIactivities, contact me via [email protected] or phone(08) 8204 6802. Anne O'Hanlon, SeniorProject Officer

Funded under the National Mental Health Strategy by the Commonwealth Department of Healthand Family Services

15

ISSN 1329-8720 June, 1999 Page 2 Issue 9 - 2/99

FAM°11ES AND MENTAL HEALTHNETWORKAn intersectoral group promoting the wellbeing offamilies with dependent children where parentshave a mental illness.

This multidisciplinary group started six years ago in

Melbourne, as the "Children's Interest Group," and wasinvolved in organising two conferences on this them in 1995and 1996. Throughout, the purpose of the group has been tolobby for improved service structure and service deliveryfor parents with mental illness and their children throughexchanging information about program, policy and servicedevelopments, providing peer support and professionaldevelopment, bringing into focus, raising consciousness andadvocating for the rights of families where one or bothparents have a mental illness, fostering intersectorallinkages, encouraging and facilitating involvement of anconsultation with family members and consumers. Themonthly meetings provide a valuable forum through whichinformation can be exchanged and networks established andmaintained. People unable to attend meetings may receivetwice yearly updates.For further information please contact the currentConvenor, Vicki Cowling, Maroondah Child and AdolescentMental Health Service, 21 Ware Crescent, Ringwood East,Victoria 3135, Phone: 03 9870 9788, Fax: 03 9870 7973.

ACHIEVNG THE ALANCE: ARESOURCE K°T FOR AUSTRALIIAN MED°APROFESVONALS FOR THE REPORTNGA°s1D PORTRAYAL OF SUCODE ANDMENTAL °ILLNESSES

Achieving the balance - a resource kit for Australian mediaprofessionals for the reporting and portrayal of suicide andmental illnesses was launched on Tuesday 22" June, 1999by the Honourable Dr Michael Wooldridge, Minister forHealth and Aged Care. The kit is the result of an extensivecollaborative effort between the Federal Government , theindustry and the community and is an initiative that bringstogether the efforts of key players to lessen the threat ofimitation suicide and reduce the stigma currently faced bypeople with a mental illness.In launching the program Dr Wooldridge said the mediacould play a central role in suicide prevention.

"This information will assist journalists who face sortingfact from myth and misinformation" (Dr Wooldridgesaid).

lb

"While the media has generally shown a sensitive andresponsible approach to suicide, in an attempt tominimise copycat attempts, improvements can still bemade".

The resource kit has six elements(outlined below) and aimsto depict and report suicide and mental health issues incontext, with relevance and sensitivity to those who may beaffected by it. The kit offers an insight into how dangerousirresponsible reporting and portrayal can be. It alsosuggests ways to ensure that newsworthy stories arereported in a sensitive manner.Suicide

a Media Resource for the reporting and portrayal ofsuicidea Life Promoting Media Strategya Media quick reference card on mental illness

Mental Illnessesa Media Resource for the reporting and portrayal ofmental illnessesa Mental Health Promoting Media Strategya Media quick reference card on mental illnesses

The two Media Resources aim to promote awareness of theissues relating to mental illnesses and suicide and how theyare addressed by the media, recognising the importantinfluence the media have on the perceptions and behavioursof the wider community.The Mental Health Promoting Strategy aims to support themedia to report and portray mental illnesses sensitively andto encourage the media to educate the community on issuesrelating to mental health and mental illnesses.The Life Promoting Strategy aims to encourage the media toportray suicide in a responsible way to minimise thepossibility of imitation suicide, or to avoid the risk ofnormalising or glamorising suicide. The Strategy is anoverarching framework that reinforces the partnershipbetween the Federal, State and Territory Governments, themedia industry; the youth, health and education sectors; andnon-government organisations to help reduce suicide.The Media quick reference cards aim to provide mediaprofessionals with easily information on mental illnessesand suicide. The quick reference cards are based on theacknowledgment that realistically, in an environment ofurgent deadlines, media professionals would not always findthe time to refer to both resources before running orbroadcasting a story. The quick reference cards provideuseful tips, checklists and contacts at the fingertips of mediaprofessionals.The Development of the Resource KitThe Resource on the reporting and portrayal of suicide wasdeveloped by Suicide Prevention Australia and theAustralian Institute for Suicide Research and Prevention,and written by expert authors. Workshops were held withmedia industry leaders and consultations took place withmany suicide prevention project workers and organisations,along with the media and mental health policy units of theNational Advisory Council on Youth Suicide Prevention.The Resource on the reporting and portrayal of mentalillnesses was developed by the Mental Health Branch of the



Department of Health and Aged Care. The initial version ofthis resource underwent the same consultation process as theresource on suicide. The resource was subsequently revisedand circulated to mental health experts for comment. It hasbeen considered by the Australian Health Ministers'Advisory Council's National Mental health Working Groupand endorsed by the Commonwealth Mental HealthPromotion and Prevention Working Party.Availability of Resource KitCopies of the Resource Kit for Australian MediaProfessionals and portrayal of suicide and mental illnessescan be obtained by contacting the Mental Health Branch,Department of Health and Aged Care. The documents arealso available on the Mental Health Branch Websitehttp://www.health.gov.auThsdd/mentalhe

EVALUATMN OF OUT OF THEPROJECT

LUES

The Out of the Blues project, funded under the YouthSuicide Prevention Initiative, was developed as a treatmentcentre for young people aged 15-24 years suffering from amood disorder. This service was designed as a SuicidePrevention Strategy given that depression is -the mostcommon feature of those who complete suicide. It closed inDecember 1998 and the Evaluation and Final Reports arecurrently being written.The unit was located at Southern Child and AdolescentMental Health (CAMHS), at the Flinders Medical Centresite and comprised a small team of clinicians,(approximately 1.7 FIE generic mental health and 1.0 F Ipsychiatry) research officer (0.5 FIB) and administrativeofficer (0.5 FTE).The aims and objectives of Out of the Blues were as follows:AIMS

To add to the existing service Southern Child andAdolescent Mental Health Services (Flinders MedicalCentre), a high quality clinical, teaching, research andpublishing unit focused on affective disorders, whichwill:

- develop, promote and disseminate good practicelocally and nationally;- actively explore issues of mental healthpromotion, early detection and intervention,treatment and management, as well as relapseprevention;- promote a national focus on these issues throughprofessional publication, national bulletins, mediadiscussion and all electronic means;

promote education in good practice for affectivedisorders in young people through nationalconferences, seminars and workshops focused onaffective disorders;

OBJECTIVESPromote access to and participation in the service byyoung people.Optimal care and treatment for young peopleStrategic alliances within the communityIntegration and influenceEvaluation

In less than 2 years the unit took in excess of 180 referralsof which 104 clients were assessed. Of these 104 clients, 98were offered ongoing treatment for a depressive disorder asa primary or secondary diagnosis.As the project evolved, through hindsight and continuousevaluation the project team found evidence indicating thatthey could meet their objectives, and fine tune the way inwhich they approached and delivered mental health servicesto young people. These ideals or `good practice' methodsof service delivery developed into 4 main themes:1. Access and Alliance2. Customer Service3. Suicide Prevention Training4. Qualitative Evaluation

1. Access and AllianceOptimum access to mental health requires the agency toattempt to provide a service that is as easy as possible forthe client to use. When the symptoms of depression and thedevelopmental features of adolescence are considered, itstands to reason that this service will need to be adaptable,flexible and respectful to young people . The way referralsare taken and processed will affect the types of clients andproblems that are presented. As a consequence, provision ofhome visits, 'community' outreach and transport will impacton attendance. Further, the atmosphere of the centre, boththe physical environment and the approach of staff (be theyclinical staff or cleaners) will impact on the client's level ofcomfort and consequent compliance.The concept of "Therapeutic Alliance" is well documentedand recognized as being strongly associated with outcomeor usefulness of therapy. Agencies need to actively promotethis by supporting alliance development in policies andregular practices within their services . Indeed, the 'care' ofour clients must be reflected in our practice. Out of theBlues has achieved this by addressing non-attendance andnon-compliance with methods that demonstrate care.Reference:Wright, S. & Martin, G. (1998) "Young People and MentalHealth - Access and Alliance". Youth Studies Australia,December 1998.

2. Customer ServiceService delivery must be actively worked on if the treatmentis to arrive at a mutual conclusion. Young people can bemore difficult to treat due to the developmental, cultural andsocial stages they are negotiating. Interagency collaborationand community linkage is vital to promote holistic treatmentthat addresses the often multiple needs of the young person.Promoting resilience in young people and their familiesrequires a co-operative and collaborative approach that

1



values all sectors of the community and the resources theycan offer. Hence, the way program staff deliver servicefrom the initial crisis to the closure of therapy needs to beexamined and practices that promote agreement,transparency and respect need to be employed.Reference:Wright, S. & Martin, G. "Young People and Mental HealthCustomer Service". (Awaiting Publication)

3. Suicide Prevention TrainingThis training format provided as part of the Out of the Bluesproject introduced participants to the signs of suicide anddepression in young people. As such, it provided educationin risk assessment, initial management and appropriatereferral to the mental health sector. Primarily, training wasaimed at the non-health sector but was also used to trainhealth professionals and students.Reference:Wright, S. & Martin, G. "Young People and Mental HealthSuicide Prevention Training". (Awaiting Publication)4. Qualitative EvaluationThe Telephone Evaluation Project was developed from aNarrative Therapy Project that invited clients to discusswhat was helpful and unhelpful in therapy . Out of the Bluesemployed two young people to follow this process using thetelephone. Clients reported that they preferred this processof evaluation. As the interviewer's skills improved and asthe process was refined the quality of informationconsequently became more informative.Reference:Wright, S., Pattison, C., Williams, K. & Martin, G. "TheTelephone Evaluation Project". (Awaiting Publication)

SUMMARY OF EVALUATIONOut of the Blues received 186 referrals over 15 months ofclinical activity. This represents an underestimate of theneed given that referrals to the unit had to be closed on atleast 2 occasions because clinicians were unable to take onnew assessments. The majority of referrals were fromparents (59), with the Adult Crisis Service referring on 25occasions, Southern CAMHS on 20, the Youth Sector on 18and General Practitioners on 18. 12 young people referredthemselves and following a careful triage process only 104young people met criteria or agreed to be seen.More than 50% were young men an unusual finding forYouth Mental Health Services. The mean age was 18.2years (range 14.8 24 years). This suggests that programstaff reached the target of servicing young people at thecrossover between child and adult services. The majority(42%) were students, though nearly 30% were employed insome capacity, 22% were unemployed.All diagnosis were made on DSM IV criteria and indicatedthat nearly 75% had a primary diagnosis of an affectivedisorder. If they did not have a first degree diagnosis ofdepression then they were likely to have a secondarydiagnosis of a depressive disorder. On all parameters (selfreport and clinician rated) this was a severely depressedgroup. Co-morbidity was a serious problem in 70%.

Although only 57 of the program's sample of young peoplehave complete data at Time 2 and only 37 are complete atTime 3, it is clear that for those who have data, substantialchange occurred throughout assessment and therapy. Boththe quantitative and qualitative data reflect this.While only 39 (45.3%) of the program's young peoplereported having attempted suicide prior to Time 1

assessment, 15 of these were in the previous month. Overallthe group rated very highly on our measure of suicidalityconfirming the link between serious affective disorder andsuicidal behaviours. By Time 2 and 3 assessments, only afew young people had re-attempted, there were no fatalitiesin the 15 months, and the suicidality scores had reducedconsiderably.At the end of the unit's life, eight of the young peopleremained severely depressed. As a group they reportedmarked ongoing family dysfunction, past histories of majorabuse, and of note they had high ongoing levels of anxiety.They consumed disproportionate amounts of the serviceresources despite their relative lack of complete recovery.However they were manageable in an outpatient setting anddid not need impatient care. These matters are detailed inthe Evaluation Report.The Telephone Evaluation shows that young peopleappreciated the dedicated focus on young people, theresponse to their expressed needs, the ambience of the unit,the easy access and the therapeutic style of the clinician.

KEY RECOMMENDATIONSThe Evaluation Report has identified a number ofrecommendations related to access issues, clinical practiceand research.These include recommendations that:

Clinical services should reflect the culture, expressedneeds and developmental context of young people andmaintain an atmosphere that promotes ease of use bythe clients. Feedback mechanisms need to be put inplace to ensure clients feel well treated and respectedwhen attending for treatment.Clinical Services should be accessible; barriers toservice need to be actively minimised.Clinical Services should be inclusive (holistic) withregard to issues of co-morbidity, rather than exclusive;young people 'referred on' (hand-balled) are less likelyto attend and become engaged in a therapeutic alliance.Clinical Services need to be high profile and/or wellknown and promoted to the young client group;services buried in generic serv ices are less likely to beaccessed, as are those identified explicitly with 'mentalhealth'.Clinical Services should have strong and meaningfulinteragency and intersectoral linkages to ensure thewidest possible collaboration; while direct managementof the depression may be the key to better personalfunctioning, a range of education, employment,accommodation and other issues must be dealt with atthis key developmental age.



LETS TALK MIENi-AL HEALTHPAMPHLETS

NESB Resource Development ProjectAs part of the Transcultural Mental Health Centre's goal ofdeveloping a collection of appropriate Mental Healthresources which will effectively address the informationneeds of NESB communities in NSW about Mental Health,the Centre has recently completed Stage 3 of the Project, thedevelopment of a series of pamphlets which aim todemystify mental illness and tackle issues of stigma,highlight the need for early intervention, as well as familyand community support. 280,000 pamphlets in 15

community languages on four Mental Health topics perlanguage are now available for distribution. The pamphletsare titled:1. About Mental Health2. Stigma and Anxiety3. Depression4. Psychotic Disorders: Schizophrenia and DelusionsCommunity languages are: Arabic; Bosnian; Cantonese;Croatian; Filipino; Greek: Italian; Khmer; Korean; Maltese;Serbian; Spanish; Turkish; Vietnamese.

This pamphlet series has been developed from thetranscripts of the professional recordings of the multiculturalradio campaign developed by the Transcultural MentalHealth Centre, in conjunction with SBS Radio duringMental Health Week.

Copies of the pamphlets are available free of charge bycontacting the Resources Officer, Transcultural MentalHealth Centre, Locked Bag 7118, PARRAMATTA BCNSW 2150

The implementation of the Transcultural Mental HealthCentre's goal of developing a collection of appropriatemental health resources commenced in October 1997 andincludes six individual stages: the mass media method ofbroadcasting through radio segments; the production ofaudio tapes; the development of written materials/pamphlets; the loading of the pamphlets onto the [email protected] the production of compact disks foreach language; and finally, a free call 1800 telephone callerinformation service in 15 community languages.

AVAILABLE NOW

The NSW Health Department has released its "Caringfor Mental Health in a Multicultural Society: A Strategyfor the Mental Health needs of People from Culturallyand Linguistically Diverse Backgrounds". Thisdocument addresses the Health Department's strategicplan in the area of multicultural health. To obtain a

copy please contact: the Better Health Centre on 029816 0452"Nobody Wants To Talk About It: Refugee Women'sMental Health". This document is available at a cost of$20 from the Transcultural Mental Health Centre,Cumberland Hospital, Locked Bag 7118,PARRAMATTA BC NSW"Hear Our Voices: Trauma, Birthing and MentalHealth among Cambodian Women". This document isavailable at a cost of $25 from the Transcultural MentalHealth Centre, Cumberland Hospital, Locked bag 7118,PARRAMATTA BC NSW

Transcultural Riiental Health Centre: 1998Awards for Excellence

Readers of AusEinetter may be interested to learn of someof the 1998 Awards for Excellence awarded by theTranscultural Mental Health Centre

Early InterventionJoe ChuongJoe Chuong provides a specialist case management andcommunity development services for the Vietnamesecommunity. He is currently working on a project topromote the early identification and intervention fordepression among the Vietnamese community in the SouthWestern Sydney Area.

Early Intervention ProgramThe NSW Spanish and Latin American Association forSocial AssistanceHijos del Sol (Children of the Sun) Hispanic Youth ProgramThis is an Association formed for Spanish speaking youth.It is run by young people and provides a range of services toassist young refugees to adjust to Australian life. Theproject provides a week long camp which addresses variousissues. The Hispanic Youth program is highly effective inaddressing resettlement, emotional and psychological issues.The project has attracted attention and increased inpopularity and the workers have provided papers toorganisations interested in adapting it for their own service.

AUSEDNET CONFERENCE: "RISK,RESDLIENCIE AND RESULTS"

AusEinet's international conference on early intervention,"Risk, Resilience and Results" was held at the AdelaideConvention Centre from 6°-8° June, 1999. An average of180 participants attended each of the three days and weregenerally positive in their comments about the conference,including the quality of the speakers and their presentations,the suitability of the venue and the conference organisation.(Approximately 80% of those participants completing the



evaluation form rated these items as 'good' or 'excellent').A number of participants commented on the challenges ofboth organising and staging a conference that would appealto a wide range of participants this was certainly a majorchallenge for the conference organisers! As with manyconferences, time was also a major constraint with many ofthe speakers having insufficient time to present.A majority of respondents reported that their participation atthe conference gave them an improved understanding of theconcepts of early intervention, risk and resiliencerespectively. Interestingly, a minority of respondentsreported that that the material presented at the conferencewould change their approach to their work.A number of leading national and international speakers inthe field of early intervention presented at the conference.These included:Professor Mark Fraser - Risk & Resilience: A Developmentand Ecological Perspective on Aggressive Behaviour inChildhood.Associate Professor David Fergusson Risk, Resilience andEarly Intervention.Professor Patrick McGorry - The Scope for EarlyIntervention in Potentially Serious Mental Illness andCommon disorders in Young People.Professor Beverley Raphael - Early Intervention: Risk,Resilience and Results.Mr Darren Bowd - Caring for All Regardful of Race, Colourand Creed - Valuing Diversity for Better Mental HealthServices for All.Dr Anne Sved-Williams - Darwin to Adelaide: Out Back orin Front?Mr Tim Keogh - Early Intervention with Serious RepeatJuvenile Offenders: A Second Chance.Dr Ian Shochet The Resourceful Adolescent Program(RAP): Towards a Comprehensive Approach to thePrevention of Adolescent Depression.Dr Allan Rosen - Early Intervention Mindset: SystemRebuilding for Early Intervention.Associate Professor Graham Martin - A Stitch in TimeMs Wendy Goodwin & Ms Tracy Hill Consumer andCarer Presentation.Unfortunately, it has been difficult to obtain copies of manyof the speakers' presentations. Those that are available(including Professor Mark Fraser and Associate ProfessorDavid Fergusson) will appear on the AusEinet website inthe near future. We would welcome copies of any otherconference presentations.

OTHIER CONFEIRENCES OF NTEREST

1. "Home and Away". NSW Child and Family HealthConference. Monday 16" August 1999. The MasonicCentre, 279 Castlereagh Street, SYDNEY

Highlights:Professor David Olds, one of the world's foremostresearchers in Child and Family Health will present twopapers:"Prenatal and infancy home visiting by nurses".Participants in the pioneering Elmira home visitation trialhave now been followed up for 15 years and the long termfollow up confirms the cost-effectiveness of this form ofintervention in promoting maternal and infant health."Program replications: linking research with practice".The Elmira study is now being replicated in many non-research settings. Data is now available from nearly 100sites in the US involving hundreds of nurses and thousandsof families, enabling important questions about theeffectiveness of roll-our from a pilot study to a large scaleinetervention to be addressedDr Ken Nunn, Chair of Division of Psychological Medicine,New Children's Hospital. "Finding a focus treatment in themulti problem family"Professor Jake Najman, Professor of Sociology, Universityof Queensland. "Poverty and its consequences for childhealth and development". There is an emerging interest inthe extent to which adult health inequalities have their originin the extent to which adult health inequalities have theirorigin at or around birth and early childhood. Socialinequalities influencing the mental and physical health ofthe child are assessed, and their relevance for communityand population health initiatives are considered.Cost $85For further information, please contact: Lindy DanversPhone: 029414 0281; Fax: 029411 6493

2. "The MHS 9th Annual Mental Health ServicesConference: Whose Realities?" 22"d-24th September,1999 Melbourne Convention Centre

The conference aims:to provide a forum for the presentation and exchange ofideas about best ways on ensuring high quality mentalhealth services for people seriously affected by mentalillness and disabilitypromote positive attitude about mental health andmental illnessprovide a forum for professional development of peopleassociated with mental health services, i.e., anopportunity to present current innovations, strategies,research, policies and future directionsprovide a forum for professionals, consumers. carersand managers to meet and debate mental health servicesstimulate debate which will challenge the boundaries ofpresent knowledge and ideas about services for peoplewith mental health disabilities

For further information, please contact ConferenceSecretariat THEMHS PO Box 192, BALMAIN NSW 2141.Phone: 02 9926 6057; Fax: 02 9926 7078; email:enquiries @themhs.org website www.themhs.org



Ongernagiona0 Conference: Cuigwee, Race and CommunigyTheme: Making it work in the new millennium.

Venue: Crest Hotel, Melbourne19-21 August 1999

Conference Program Highlights

Thursday 19 August 1999DAY ONE - BELIEFS & THEORY

D About cultural and racial differenceD About ethnic and cultural identityD About racism and inter-group relations

8.00 am Registration9.00 am Welcome & Official Opening Ceremony9.40 am OPENING ADDRESS

The Hon Phillip RuddockFederal Minister for Immigration andMulticultural Affairs, Canberra

10.00 am KEYNOTE ADDRESSMulticultural Societies: Concepts and IssuesProfessor John Berry, Queensland University,Canada

10.30 am Morning Tea11.00 am KEYNOTE ADDRESS

Race and Difference: Myths and FactsProfessor Emeritus Marshall Segal, SyracuseUniversity, New York, USA

12.00 pm Exhibition and Cultural Performance12.30 pm Luncheon1.30 pm Concurrent Sessions Papers & Workshop

Discussion3.30 pm Afternoon Tea4.00 pm Plenary Panel Discussion

Chair: Associate Professor Harry Minas, Vic.5.00 pm Welcome Reception

Friday 20 August 1999DAY TWO - EFFECTS & REALITIES

D Living with cultural diversity in all walks of lifeD Developing services and programs in accommodating

differenceD Increasing equity and access

9.00 am KEYNOTE ADDRESSProfessor Henry Reynolds

10.00 am

10.30 am11.00 am12.30 pm2.00 pm3.30 pm4.00 pm

5.00 pm

ResponseProfessor John Berry and Professor EmeritusMarshall SegalMorning TeaConcurrent Sessions - Papers & WorkshopLuncheon and Poster DisplayConcurrent Sessions - Papers & WorkshopAfternoon TeaPlenary SessionPanel DiscussionChair: Mr Haas Dellal, Executive Director,Australian Multicultural FoundationClose

Saturday 21 August 1999DAY THREE - PRACTICALITIES & POSSIBILITIES

D. Encountering the issues in managing differenceD Promoting good practice for the benefit of multicultural

communitiesD Forging links for successful cohesion

9.00 am KEYNOTE ADDRESSMr Nigel Milan, Managing Director, SBSAustralia

9.30 am KEYNOTE ADDRESSMr John Cook, Managing Director, BerriLimited, Australia

10.00 am ResponseProfessor John Berry and Professor EmeritusMarshall Segal

10.30 am Morning Tea11.00 am Concurrent Sessions - Papers & Workshop12.30 pm Luncheon & Cultural Performance2.30 pm Plenary Session

Panel DiscussionChair: Mr John Cook

3.00 pm Visionary Statement Where to From Here?3.30 pm Closing Ceremony & Refreshments.

ENQUIRIES

For further details regarding the conference, please contact:The Conference Organiser

PO Box 214, Brunswick East, Victoria, Australia, 3057Telephone: (61) (03) 9380 1429

Fax: (61) (03) 9380 2722Email: [email protected]

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CON§UMER FORUM ,ON EARLY'INTERVENTIoN .

AusEinetis currently cOnsidering tile feasibility ofconducting a coniumer forum on,eariyinfprvention:The project team IS keen to identify key consumer

gimps and' indMduals who may be interested in havinginputinto sudh (forum At*auggestiOns wOuld be

; niost gratefullY appreciated.. POasa contadt: Call*Davia t AusEinef: Email:

,C.Diwisesignadou.aculidu:au.'fax: 08 8357 5484;phone04`1 120 8484-

SOUTH AUSTRALDAN SOBUNG PROJIECT

A new project has been established at the Adelaide Womenand Children's Hospital to develop and co-ordinateresources and services for siblings of children withdisabilities and chronic illness. Specific activities plannedinclude:

Networking with other people around AustraliaConducting focus groups with parents of children withdisabilities and chronic illnessPlanning and undertaking workshops with youngsiblings of children with disabilities and chronic illnessDevelopment of a discussion paper withrecommendations

The development of this project highlights the increasingawareness of the importance of early intervention in thisarea. Chronically ill/disabled children have a profoundimpact on the family. Although there is no completeconsensus about the effect of chronic childhoodillness/disability on a family, the bulk of the evidence seemsto suggest that ongoing physical illness or disability maydisrupt the entire fabric of a family and have significantpsychological and financial costs as well as costs tointerpersonal relationships (Jessop and Stein 1989; Drotarand Bush 1985). Researchers including Steinhauer andcolleagues (1974) have discussed sibling reactions tochronic physical illness. They have identified as important,jealousy and resentment toward the child who gains theattention and energies of the family unit. The parentalpreoccupation with the sick child and their o wn reactions tohis/her illness may result in their experiencing a certaindegree of emotional deprivation. Feelings and expression ofjealousy, resentment and hostility that are not allowed to beadequately expressed often result in withdrawal, schoolproblems, adolescent delinquency, and behaviouralproblems or other acting-out behaviour among thephysically intact siblings (Silverman and Koretz 1989).Existing literature suggests that if mechanisms aredeveloped to provide support for the siblings of childrenwith disabilities and chronic illness, the mental health status

of these children is enhanced and they are able to provideongoing support to their disabled/chronically ill sibling.

At this stage, the project has funding through until October1999 through Community Benefit SA but it is hoped tosecure longer term funding.ReferencesDrotar, D. & Bush, M. (1985) Mental health issues andservices. In N. Hobbs & J.M. Perrin (Eds.) Issues in thecare of children with chronic illness. San Francisco: JosseyBass, pages 517-527.Jessop, D.J. & Stein, R.E. (1989) Meeting the needs ofindividuals and families. In R.E. Stein (Ed.) Caring forchildren with chronic illness: issues and strategies. NewYork: Springer Publishing Co, pages 63-74.Silverman, M.M. & Koretz, D.S. (1989) Preventing mentalhealth problems. In R.E. Stein (Ed.) Caring for childrenwith chronic illness: issues and strategies. New York:Springer Publishing Co, pages 213-229.Steinhauer, P.D., Mushin, D.N. & Rae-Grant, 0. (1974)Psychological aspects of chronic illness. In The PediatricClinics of North America. 21 Philadelphia: Saunders, pages825-840.For further information contact the Project Officer, Ms KateStrohm, CI- Dept of Psychological Medicine, Women's &Children's Hospital, 72 King William road, North Adelaide,SA, 5006, Ph. 08 8204 7227, fax 08 8204 7032, or Email:sibproject @ wch. sa. gov. au

AUSEI1NET DATABASEThe AusEinet database is steadily developing. To assist usplease complete the following details and forward toAusEinet if you would like to be informed of futureAusEinet activities, nationally or in your own State orTerritory.

Please let us know if we have incorrect address details.

Name:

Organisation:

Address:

P/C

Telephone. Facsimile.

Email:Return to AusEinet C/- CAMHS, Flinders Medical Centre,Bedford Park SA 5042. Telephone: 08 8357 5788Facsimile: 08 8357 5484 Email: [email protected] NEXT ISSUE WILL BE PRODUCED IN SEPTEMBER.DEADLINE FOR MATERIAL WILL BE FRIDAY 10ThSEPTEMBER 1999. PLEASE LET US KNOW WHAT YOU AREDOING. CONTACT AUSEINET WITH SUGGESTIONS FOR TOPICS

TO BE COVERED.

AUSEINET WEBSITE ADDRESS http://auseinet.flinders.edu.au

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