DOC on Campus: A General DOC on Campus: A General Practice Initiative for Early Practice Initiative for Early

Detection and Intervention of Detection and Intervention of Mental Health Problems in a Mental Health Problems in a Rural Australian Secondary Rural Australian Secondary

SchoolSchool

Presented by Dr Anke Doley and Colin Sibly

A 15 year old male student expressing his feelings

Why consult at a school?Why consult at a school? Collaboration work with schools provides the opportunity Collaboration work with schools provides the opportunity

for both the effective delivery of services without stigma for both the effective delivery of services without stigma and is cost effective. (Manikan 2002, 28) and is cost effective. (Manikan 2002, 28)

If early intervention is going to be effective the serviceIf early intervention is going to be effective the service must be ‘youth-friendly’ which means it has to bemust be ‘youth-friendly’ which means it has to be ConfidentialConfidential AccessibleAccessible Affordable Affordable

The ‘Doc on Campus’ (DOC) programThe ‘Doc on Campus’ (DOC) programstarted in May 2004 on campus of a regional high school. started in May 2004 on campus of a regional high school. Since then over 162 students have accessed the program Since then over 162 students have accessed the program so farso farseeking support in a range of mental health issues.seeking support in a range of mental health issues.Of those 162 students 34% (54) students were male . Of those 162 students 34% (54) students were male . In 2008 52% (16) were male. For 2009 the male In 2008 52% (16) were male. For 2009 the male participation rate is 45% so far. participation rate is 45% so far.

Being located in a rural community, the ‘DOC’ team have Being located in a rural community, the ‘DOC’ team have formally and informally followed the progress of some of formally and informally followed the progress of some of the young people who have been part of the program and the young people who have been part of the program and reported that a “significant number of ‘troubled’ reported that a “significant number of ‘troubled’ adolescents have been able to effectively re-engage with adolescents have been able to effectively re-engage with learning and with life in our community”(C.Sibly School learning and with life in our community”(C.Sibly School Counsellor). Counsellor).

How does Doctor on How does Doctor on Campus work?Campus work?

School counsellor initiates referral to the GP School counsellor initiates referral to the GP (with comprehensive information supplied to the GP) and (with comprehensive information supplied to the GP) and

organises parental consent if the patient is under the age of 15 yearsorganises parental consent if the patient is under the age of 15 years

Review by the GP Review by the GP (who visits the school for 1 session fortnightly)(who visits the school for 1 session fortnightly)

and organisesand organises

If indicated If indicated a referral to a psychologist (via a Mental Health Plan a referral to a psychologist (via a Mental Health Plan

and More Allied Health Services Program funding (MAHS)and More Allied Health Services Program funding (MAHS)via a local Division of General Practice) via a local Division of General Practice)

General Practitioners are primary care givers General Practitioners are primary care givers in the early intervention of mental health but in the early intervention of mental health but

adolescents are missing out.adolescents are missing out.

There is a 14% national prevalence rate of mental health There is a 14% national prevalence rate of mental health problems for children and adolescents in Australia (Sawyer problems for children and adolescents in Australia (Sawyer et al. (2000)et al. (2000)

With about 100,000 young people experiencing anxiety or With about 100,000 young people experiencing anxiety or depression. However, over depression. However, over 60% of young people60% of young people experiencing anxiety or depression experiencing anxiety or depression don't don't seek professional seek professional help (Mental Health Council of Australia, 2000)help (Mental Health Council of Australia, 2000)

Only 25% of young people with significant mental health Only 25% of young people with significant mental health problems attend a service with just 8% reaching a child and problems attend a service with just 8% reaching a child and adolescent mental health service Sawyer et al. (2000) adolescent mental health service Sawyer et al. (2000)

Due to these increased rates early intervention for young Due to these increased rates early intervention for young people is a priority and evidence for its effectiveness is people is a priority and evidence for its effectiveness is emerging (McGorry, & Jackson, 1999; Clarke, et al., 1995). emerging (McGorry, & Jackson, 1999; Clarke, et al., 1995).

19 year old high school 19 year old high school patient patient who had cut herself who had cut herself

Bringing GP’s into Bringing GP’s into schoolsschools

Manikan (2002, 22-3) concludes that schools Manikan (2002, 22-3) concludes that schools are the most powerful contexts to both educate are the most powerful contexts to both educate and treat children and adolescents, and yet and treat children and adolescents, and yet there are no proper services for assessing and there are no proper services for assessing and providing intervention in mental health for providing intervention in mental health for students. students.

General Practitioners are primary care givers in General Practitioners are primary care givers in the early intervention of mental health and the early intervention of mental health and collaboration work with schools provides the collaboration work with schools provides the opportunity for both the effective delivery of opportunity for both the effective delivery of services without stigma and is cost effective. services without stigma and is cost effective. (Manikan 2002, 28) (Manikan 2002, 28)

Case conferencing = Teamwork = Resource poolingCase conferencing = Teamwork = Resource poolingthrough:through:

school based intervention school based intervention psychological intervention and psychological intervention and

medical interventionmedical intervention= learning from each other= learning from each other

Mental disorders among youth people Mental disorders among youth people have correspondingly impacts on have correspondingly impacts on

educational achievement, and increased educational achievement, and increased levels of unemployment. (McGorry et al levels of unemployment. (McGorry et al

2007)2007) General Practitioners are primary care givers in the General Practitioners are primary care givers in the

early intervention of mental health.early intervention of mental health. Emotional and behavioural problems among children Emotional and behavioural problems among children

and young people are widespread. Incidence rates of and young people are widespread. Incidence rates of mental health problems and illness, including those mental health problems and illness, including those likely to continue into adulthood, elevate in the 12-likely to continue into adulthood, elevate in the 12-25 year age group (Commonwealth Department of 25 year age group (Commonwealth Department of Health & Aged Care, 2000a). Health & Aged Care, 2000a).

Sawyer et al. (2000) reported a 14% national Sawyer et al. (2000) reported a 14% national prevalence rate of mental health problems for prevalence rate of mental health problems for children and adolescents. Anxiety and depression children and adolescents. Anxiety and depression are the most common mental health problems for are the most common mental health problems for people aged 12 - 17 years. people aged 12 - 17 years.

Mental disorders account for 55% of disease burden Mental disorders account for 55% of disease burden in those aged 15-24 years. in those aged 15-24 years.

Our vision and hopesOur vision and hopes

To obtain funding for a long term study and follow upTo obtain funding for a long term study and follow up To extend this pilot program to other schools,To extend this pilot program to other schools, To gain financial support as adolescent mental health To gain financial support as adolescent mental health

is time intensive with an unreliable patient base, is time intensive with an unreliable patient base, To improve the knowledge base in adolescent mental To improve the knowledge base in adolescent mental

health for GP’s with courses similar to the “headstart” health for GP’s with courses similar to the “headstart” program,program,

To encourage incentives for allied health professionals To encourage incentives for allied health professionals to consult within schools, to consult within schools,

To improve the depth of support e.g. through To improve the depth of support e.g. through introductory/bridging courses for school counsellors introductory/bridging courses for school counsellors and and

To support rural areas by encouraging psychology To support rural areas by encouraging psychology and adolescent psychiatric services to consult in rural and adolescent psychiatric services to consult in rural areas e.g. by providing travel allowances/incentives areas e.g. by providing travel allowances/incentives “rural 291” or teleconferencing.“rural 291” or teleconferencing.

A 15 y.o. male student expressing his feelings

Thank you for your support

Please consider giving Please consider giving young people a handyoung people a hand