TY - JOUR
T1 - Clinicians' perceptions of the Australian Paediatric Mental Health Service System
T2 - Problems and solutions
AU - Paton, Kate
AU - Gillam, Lynn
AU - Warren, Hayley
AU - Mulraney, Melissa
AU - Coghill, David
AU - Efron, Daryl
AU - Sawyer, Michael
AU - Hiscock, Harriet
N1 - Funding Information:
We would like to thank Shea Rendall for her assistance in interviewing participants. This research project was completed as part of the ?Towards an evidence-based and equitable mental health system for children in Australian project?. The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: The project?s study design and conduct, data collection, management, analysis and interpretation were funded by National Health and Medical Research Council (NHMRC) Grant No. 1129957. H.H. is supported by NHMRC Practitioner Fellowship Award 1136222. The Murdoch Children?s Research Institute administered the grants and provided infrastructural support to its staff but played no role in the conduct or analysis of the research. D.F.?s position is funded by a Clinician Scientist Fellowship from MCRI. The Victorian Government?s Operational Infrastructure Support Program support research at the Murdoch Children?s Research Institute.
Publisher Copyright:
© The Royal Australian and New Zealand College of Psychiatrists 2021.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - OBJECTIVES: Despite substantial investment by governments, the prevalence of mental health disorders in developed countries remains unchanged over the past 20 years. As 50% of mental health conditions present before 14 years of age, access to high-quality mental health care for children is crucial. Barriers to access identified by parents include high costs and long wait times, difficulty navigating the health system, and a lack of recognition of the existence and/or severity of the child's mental health disorder. Often neglected, but equally important, are clinician views about the barriers to and enablers of access to high-quality mental health care. We aimed to determine perspectives of Australian clinicians including child and adolescent psychiatrists, paediatricians, psychologists and general practitioners, on barriers and enablers within the current system and components of an optimal system.METHODS: A total of 143 clinicians (approximately 35 each of child and adolescent psychiatrists, paediatricians, child psychologists and general practitioners) from Victoria and South Australia participated in semi-structured phone interviews between March 2018 and February 2019. Inductive content analysis was applied to address the broad study aims.FINDINGS: Clinician-identified barriers included multi-dimensional family factors, service fragmentation, long wait times and inadequate training for paediatricians and general practitioners. Rural and regional locations provided additional challenges but a greater sense of collaboration resulting from the proximity of clinicians in rural areas, creating an opportunity to develop support networks. Suggestions for an optimal system included novel ways to improve access to child psychiatry expertise, training for paediatricians and general practitioners, and co-located multidisciplinary services.CONCLUSION: Within the current mental health system for children, structural, training and workforce barriers prevent optimal access to care. Clinicians identified many practical and systemic ideas to improve the system. Implementation and evaluation of effectiveness and cost effectiveness of these ideas is the next challenge for Australia's children's mental health.
AB - OBJECTIVES: Despite substantial investment by governments, the prevalence of mental health disorders in developed countries remains unchanged over the past 20 years. As 50% of mental health conditions present before 14 years of age, access to high-quality mental health care for children is crucial. Barriers to access identified by parents include high costs and long wait times, difficulty navigating the health system, and a lack of recognition of the existence and/or severity of the child's mental health disorder. Often neglected, but equally important, are clinician views about the barriers to and enablers of access to high-quality mental health care. We aimed to determine perspectives of Australian clinicians including child and adolescent psychiatrists, paediatricians, psychologists and general practitioners, on barriers and enablers within the current system and components of an optimal system.METHODS: A total of 143 clinicians (approximately 35 each of child and adolescent psychiatrists, paediatricians, child psychologists and general practitioners) from Victoria and South Australia participated in semi-structured phone interviews between March 2018 and February 2019. Inductive content analysis was applied to address the broad study aims.FINDINGS: Clinician-identified barriers included multi-dimensional family factors, service fragmentation, long wait times and inadequate training for paediatricians and general practitioners. Rural and regional locations provided additional challenges but a greater sense of collaboration resulting from the proximity of clinicians in rural areas, creating an opportunity to develop support networks. Suggestions for an optimal system included novel ways to improve access to child psychiatry expertise, training for paediatricians and general practitioners, and co-located multidisciplinary services.CONCLUSION: Within the current mental health system for children, structural, training and workforce barriers prevent optimal access to care. Clinicians identified many practical and systemic ideas to improve the system. Implementation and evaluation of effectiveness and cost effectiveness of these ideas is the next challenge for Australia's children's mental health.
KW - children
KW - Health service use
KW - mental health
KW - qualitative
UR - http://www.scopus.com/inward/record.url?scp=85099691011&partnerID=8YFLogxK
U2 - 10.1177/0004867420984242
DO - 10.1177/0004867420984242
M3 - Article
C2 - 33461341
SN - 0004-8674
VL - 55
SP - 494
EP - 505
JO - Australian and New Zealand Journal of Psychiatry
JF - Australian and New Zealand Journal of Psychiatry
IS - 5
ER -