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Age group 12 to 17 years

Mental health

Good mental health is an essential component of wellbeing and means that young people are more likely to have fulfilling relationships, cope with adverse circumstances and adapt to change.

Poor mental health is associated with behavioural issues, a diminished sense of self-worth and a decreased ability to cope. This has adverse effects on a young person’s quality of life, emotional wellbeing and relationships as well as their capacity to engage in school and other activities.1

Overview and areas of concern

This indicator reports on a number of key measures that track whether young people in WA are mentally healthy. These includes the measures that consider the prevalence of mental health issues for young people aged 12 to 17 years and measures that report mental health service use by young people in WA. This indicator also considers incidences of self-harm and suicide.

Key risk factors for mental health issues in young people include family socio-economic disadvantage, parental mental health, child temperament, bullying, experience of domestic violence, abuse or a traumatic event.1,2,3,4

Data overview

There is limited reliable data which accurately reflects the prevalence of mental health issues for young people in WA.

The data that is available is often measuring the delivery of services rather than the prevalence of mental health issues or the perspectives and experiences of WA young people.

The Commissioner’s Speaking Out Survey, scheduled for release in early 2020, will provide some further data on the experiences and opinions of WA’s children and young people regarding their mental health.

Areas of concern

Limited data is available to assess whether mental health outcomes for WA young people aged 12 to 17 years have improved as a result of any changes in mental health service provision and investment.

Suicide is the main cause of preventable deaths for WA young people.

From 2013 to 2017, the age-specific death rate due to suicide for Aboriginal children and young people aged five to 17 years in WA was almost 10 times higher than non-Aboriginal children and young people in WA (20.2 per 100,000 persons compared to 2.1 per 100,000 persons).5

Children and young people in regional and remote areas of WA are more likely to experience significant mental health issues.

Research shows that young people in care are significantly more likely to have mental health issues than other young people,6 yet there is no data publicly available on the mental health of young people in care in WA or the provision of mental health services to these young people.

Endnotes

  1. Christensen D et al 2017, Longitudinal trajectories of mental health in Australian children aged 4-5 to 14-15 years, PLoS ONE, Vol 12, No 11.
  2. Center on the Developing Child 2018, Toxic Stress, Harvard University [website].
  3. Moore S et al 2017, Consequences of bullying victimization in childhood and adolescence: A systematic review and meta-analysis, World Journal of Psychiatry, Vol 7, No 60.
  4. Australian Institute of Family Studies (AIFS) 2015, Children's exposure to domestic and family violence: Key issues and responses: CFCA Paper No. 36 – December 2015, AIFS.
  5. Australian Bureau of Statistics (ABS) 2018, 3303.0 - Causes of Death, Australia, 2017, Intentional Self-Harm in Aboriginal and Torres Strait Islander people, ABS.
  6. Sawyer M et al 2007, The mental health and wellbeing of children and adolescents in home-based foster care, The Medical Journal of Australia, Vol 186, No 4.
Measure: Positive outlook on life

Research shows that an optimistic or positive outlook on life is a protective factor for mental health issues, in particular anxiety and depression.1 It is generally recognised that children, young people and adults have a particular ‘attribution style’ or disposition towards optimism or pessimism which influences the way they interpret events that happen in their lives.2,3 Research also suggests that it is possible to adjust a person’s disposition towards a more positive frame through targeted interventions including therapy.4,5

A positive outlook is also important for children and young people as they develop their identity and imagine their future selves. Research suggests that having the ability to imagine a positive version of a future self is linked to better health and educational outcomes, including reduced drug use, less sexual risk-taking behaviours and less involvement in violence.6

Limited information exists about WA young people’s outlook on life, particularly for young people under the age of 15 years. Where data does exist, it often includes young people over the age of 17 years.

In the annual Mission Australia 2018 Youth Survey, 28,286 young people across Australia aged 15 to 19 years responded to questions across a broad range of topics including education and employment, influences on post-school goals, housing and homelessness, participation in community activities, general wellbeing, values and concerns, preferred sources of support, as well as feelings about the future.7

In total, 3,202 young people from WA aged 15 to 19 years responded to Mission Australia’s Youth Survey 2018.8 Mission Australia recommend caution when interpreting and generalising the results for certain states or territories because of the small sample sizes and the imbalance between the number of female young people and male young people participating in the survey.

More than one-half of WA respondents (54.8%) were female and 40 per cent were male. A total of 215 (6.8%) respondents from WA identified as Aboriginal and/or Torres Strait Islander.9

The Mission Australia survey is not a representative sample and does not provide data on young people who are 12 to 14 years of age, however, it does provide an indication of WA young people’s wellbeing.

In the Mission Australia survey, young people are asked how positive they feel about the future. In 2018, WA participants were slightly less optimistic than Australian participants overall.

Feelings about the future of young people aged 15 to 19 years, in per cent, WA and Australia, 2016, 2017 and 2018

WA

Australia

2016

2017

2018

2016

2017

2018

Very positive

14.3

13.5

11.6

17.3

15.8

15.5

Positive

44.7

44.3

45.8

47.1

46.6

46.7

Neither positive or negative

28.5

30.0

30.9

26.1

27.5

27.9

Negative

7.2

8.2

7.9

6.5

7.1

6.8

Very negative

5.4

3.9

3.8

3.0

3.1

3.1

Source: Mission Australia, Youth Survey Report 2016, 2017 and 2018

The trend over the last three years was mixed, with fewer WA young people feeling very positive in 2018 than 2016, however fewer also felt very negative.

Of concern is in 2018 over one in ten respondents from WA felt very negative (3.8%) or negative (7.9%) about the future. This was consistent with the two prior years.

Feelings about the future of young people aged 15 to 19 years by gender, in per cent, WA, 2018

Male

Female

Very positive

13.8

10.0

Positive

47.9

44.4

Neither positive or negative

27.2

33.5

Negative

6.7

8.7

Very negative

4.3

3.5

Source: Mission Australia 2018, Mission Australia Youth Survey Report 2018

Feelings about the future of young people aged 15 to 19 years by gender, in per cent, WA, 2018

Source: Mission Australia 2018, Mission Australia Youth Survey Report 2018

WA female young people were less likely to feel very positive or positive about the future than WA male young people (54.4% of female young people compared to 61.7% of male young people).

Participants were also asked to rate how happy they were with their life as a whole. While most WA participants were happy with their lives, they were less likely than the Australian average to respond that they were happy or very happy (55.2% compared to 62.3%).

Feelings of happiness, young people aged 15 to 19 years by gender, in per cent, WA and Australia, 2018

WA

Australia

Total

Male

Female

Total

Happy/very happy

55.2

60.9

52.5

62.3

Not happy or sad

31.4

29.3

33.4

27.7

Sad/very sad

13.4

9.8

14.3

10.0

Source: Mission Australia Youth Survey Report 2016, 2017 and 2018

There were differences between male and female responses with only 52.5 per cent of WA female young people stating they were happy or very happy, contrasted with 60.9 per cent of WA male young people. Of concern is that 14.3 per cent of female respondents from WA felt sad or very sad.

In the 2018 survey, young people were also asked to rate how concerned they were about a number of issues. The top three issues of personal concern for young people aged 15 to 19 years from WA were coping with stress (44.2% extremely concerned or very concerned), school or study problems (34.2% extremely concerned or very concerned) and mental health (33.2% extremely concerned or very concerned). These were the same top three issues identified at the national level.10 Around 31.3 per cent of respondents were also either extremely concerned or very concerned about body image.

While the top issues were principally the same, a significantly higher proportion of female young people expressed concern than male young people across most issues.  

Proportion of young people aged 15 to 19 years extremely or very concerned about identified issues by gender, in per cent, WA, 2018

Female

Male

Extremely concerned

Very concerned

Total

Extremely concerned

Very concerned

Total

Coping with stress

26.8

30.0

56.8

10.6

17.0

27.6

School or study problems

17.6

24.2

41.8

8.5

15.3

23.8

Mental health

21.7

19.4

41.1

10.3

11.6

21.9

Body image

19.5

22.7

42.2

6.5

9.5

16.0

Physical health

9.8

17.8

27.6

7.6

13.0

20.6

Source: Mission Australia 2018, Mission Australia Youth Survey Report 2018

Proportion of young people aged 15 to 19 years extremely or very concerned about identified issues by gender, in per cent, WA, 2018

Source: Mission Australia 2018, Mission Australia Youth Survey Report 2018

More than double the number of female young people reported that they were extremely or very concerned about coping with stress than male young people (56.8% compared to 27.6%). A very high proportion of WA female participants (42.2%) were concerned about body image, in comparison to 16 per cent of male participants. These findings are similar to the national results.

The Commissioner’s Speaking Out Survey, scheduled for release in early 2020, will provide some further data on the experiences and opinions of WA’s young people regarding their outlook on life.

Endnotes

  1. Conversano C et al 2010, Optimism and Its Impact on Mental and Physical Well-Being, Clinical Practice & Epidemiology in Mental Health, Vol 6.
  2. Seligman M et al 1984, Attributional style and depressive symptoms among children, Journal of Abnormal Psychology, Vol 93, No 2.
  3. Conversano C et al 2010, Optimism and Its Impact on Mental and Physical Well-Being, Clinical Practice & Epidemiology in Mental Health, Vol 6.
  4. Roberts CM et al 2018, Efficacy of the Aussie Optimism Program: Promoting Pro-social Behavior and Preventing Suicidality in Primary School Students. A Randomised-Controlled Trial, Frontiers in Psychology, Vol 8.
  5. MacGowan M and Engle B 2010, Evidence for Optimism: Behavior Therapies and Motivational Interviewing in Adolescent Substance Abuse Treatment, Child and Adolescent Psychiatric Clinics of North America, Vol 19, No 3.
  6. Johnson SL et al 2014, Future Orientation: A Construct with Implications for Adolescent Health and Wellbeing, International Journal of Adolescent Mental Health, Vol 26, No 4.
  7. Carlisle E et al 2018, Youth Survey Report 2018, Mission Australia, p. 3.
  8. Ibid, p. 169.
  9. Ibid, p. 169.
  10. Ibid, p. 176.
Measure: Experience of mental health issues

Estimates suggest that approximately three-quarters of adult mental illnesses were diagnosed in adolescence and one-half were diagnosed before 15 years of age.1

Mental health2 issues in children and young people can be caused by multiple inter-dependent factors including a young person’s genetic pre-disposition (e.g. temperament and other health issues such as intellectual disability, ADHD etc.) and their exposure to adverse experiences or environments such as poverty, family breakdown and mental health problems of a parent.3

Young people aged 12 to 17 years often face mental health challenges, including in areas such as sexual health, alcohol and drug use, body image and risk-taking behaviours, that stem from the physical, behavioural, psychological and cognitive changes they are experiencing.4,5

Mental health issues impact young people’s ability to form healthy relationships, participate in learning and cope with adversity. Mental health issues in young people are also associated with impaired social functioning, unemployment, substance abuse and violence.6 In some instances mental illness can lead to psychosocial disability where a person is unable to participate fully in life due to mental ill-health.7

Reliable data that provides information about the extent to which WA young people experience mental health problems and disorders is limited.

The most comprehensive research on the mental health and wellbeing of children and young people in WA was the Western Australian Child Health Survey in 1995 and the Western Australian Aboriginal Child Health Survey in 2005. These surveys found that more than one in six children aged four to 16 years had a mental health problem8 and almost one in four (24%) Aboriginal children aged four to 17 years were at high risk of clinically significant emotional or behavioural difficulties.9 These surveys have not been repeated.

The 2015 Report on the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing (Young Minds Matter) conducted by the Telethon Kids Institute for the Australian Government provided a comprehensive analysis of the mental health of Australian children and young people aged four to 17 years. Unfortunately, this survey could not produce estimates of mental disorders and service use at the state and territory level or for Aboriginal children and young people.10

The Young Minds Matter survey used a number of diagnostic modules from the Diagnostic Interview Schedule for Children Version IV11 to assess mental disorders in Australian children and adolescents. Under DISC-IV, disorder status is determined according to criteria of the Diagnostic and Statistical Manual of Mental Disorders Version IV (DSM_IV).12

This survey estimated the 12-month prevalence of mental disorders among Australian 12 to 17 year-olds by gender and mental disorder category as outlined in the following table.

12-month prevalence of mental disorders among 12 to 17 year-olds by gender and mental disorder category, in per cent, Australia, 2015

Male

Female

Total

Anxiety disorders

6.3

7.7

7.0

Major depressive disorders

4.3

5.8

5.0

Attention deficit hyperactivity disorder (ADHD)

9.8

2.7

6.3

Conduct disorder

2.6

1.6

2.1

Any mental disorder

15.9

12.8

14.4

Source: Lawrence D et al 2015, The Mental Health of Children and Adolescents: Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing

Among young people aged 12 to 17 years, anxiety disorders (7.0%) and ADHD (6.3%) and were the most common.13

12-month prevalence of mental disorders among 12 to 17 year-olds, by gender and mental disorder category, in per cent, Australia, 2015

Source: Lawrence D et al 2015, The Mental Health of Children and Adolescents: Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing

There were differences between male and female young people. Male young people aged 12 to 17 years are more likely to be diagnosed with ADHD (9.8% compared to 2.7%) while female young people are more likely to be diagnosed with anxiety disorders (7.7% to 6.3%) and major depressive disorders (5.8% compared to 4.3%). It should be noted that research suggests that female children and young people are under‑diagnosed for ADHD, as the symptoms are less overt and often co-exist with different disorders from male children and young people.14,15

The WA Department of Health, administers the WA Health and Wellbeing Surveillance System, interviewing WA parents and carers of children aged 0 to 15 years.16 In this survey they ask parents and carers about their children’s socio-emotional behaviour and mental health.

In the combined years of 2015 and 2016, WA parents and carers reported that approximately one in 24 children (4.2%) aged six to 15 years had been diagnosed with ADHD. This is similar to the proportion parents and carers reported were diagnosed in 2009-10.17 A comparison to the Young Minds Matter survey which found that 8.2 per cent of four to 11 year-olds had ADHD (determined through a DISC-IV interview) highlights that mental health issues can be under-diagnosed in children.

The following table outlines the parent and carer reports of children and young people who have ever been treated for an emotional or mental health problem.

Proportion of children and young people ever treated for an emotional or mental health problem by age group, in per cent, WA, 2009-10 to 2015-16 (combined calendar years)

6 to 10 years

11 to 15 years

2009-10

5.1

10.6

2011-12

6.5

9.7

2013-14

5.3

14.0

2015-16

9.9

12.2

Source: Custom report provided to the Commissioner for Children and Young People WA from the WA Department of Health Epidemiology Branch, Selected risk factor estimates for WA children using the WA Health and Wellbeing Surveillance System, 2009-2016 [unpublished]

In the combined calendar years of 2015 and 2016, WA parents and carers reported that approximately 9.9 per cent of children aged six to 10 years and 12.2 per cent of children aged 11 to 15 years had been treated for an emotional or mental health problem in their lifetime.

Parents and carers reported that approximately one in 10 girls and one in eight boys aged six to 15 years were treated for an emotional or mental health problem.

Proportion of children and young people aged 6 to 15 years ever treated for an emotional or mental health problem by gender, in per cent, WA, 2009-10 to 2015-16 (combined calendar years)

Male

Female

Total

2009-10

9.1

6.7

8.0

2011-12

9.4

6.8

8.1

2013-14

13.0

6.9

9.9

2015-16

12.5

9.7

11.1

Source: Custom report provided to the Commissioner for Children and Young People WA from the WA Department of Health Epidemiology Branch, Selected risk factor estimates for WA children using the WA Health and Wellbeing Surveillance System, 2009-2016 [unpublished]

Parents and carers were also asked whether they thought their child needed special help for an emotional, concentration or behavioural problem.

Proportion of children and young people aged 5 to 15 years reported to need special help, by age group, in per cent, WA, 2012 to 2017

5 to 9 years

10 to 15 years

2012

31.5

29.5

2013

31.8

36.2

2014

32.7

43.7

2015

24.8*

44.8

2016

39.2

37.4

2017

46.5

28.1

Source: Merema M and Radomiljac A 2018, Health and Wellbeing of Children in Western Australia in 2017, Overview and Trends, WA Department of Health (and previous years’ reports)18

* Prevalence estimate has a relative standard error of 25 per cent to 50 per cent and should be used with caution.

In 2017, the proportion of young people aged 10 to 15 years whose parents and carers felt they needed special help was 28.1 per cent, this was lower than the proportion of children aged five to nine years (46.5%). The high proportions across age groups will be in part because the term ‘special help’ is very broad and incorporates concentration and behavioural issues.

The results for children and young people aged 10 to 15 years is relatively consistent with the Young Minds Matter survey where just over a quarter (26.8%) of all Australian parents and carers reported that in the previous 12 months their child or adolescent had some need for help for emotional or behavioural problems. In this survey (conducted in 2007) the most common type of help identified was counselling or talking therapy.19

The Young Minds Matter survey highlights the difficulty of relying on parent-reported data rather than diagnostic assessment. This survey identified children meeting the DSM-IV criteria for mental disorders, including clinically significant impairment of functioning, yet 21 per cent of parents of these children did not identify any need for help for their child.20 However, the researchers noted this was particularly significant for the children aged four to 11 years.21

The Young Minds Matter survey also found that children in low-income families, with parents and carers with lower levels of education and with higher levels of unemployment had higher rates of mental disorders.22 Other Australian research has determined that in the most disadvantaged quintile, the percentage (24.4%) of adults with mental disorders was 50 per cent higher than that in the least disadvantaged quintile (16.9%).23

The Young Minds Matter survey also reported a higher rate of mental disorders in non-metropolitan areas.24

Research conducted by ReachOut Australia and Mission Australia with young people aged 15 years and over living in regional and remote Australia found that challenges associated with living in regional or remote areas included feelings of loneliness, isolation, boredom and aimlessness due to a lack of social, recreational and/or employment opportunities.25

Children and young people with parents who have a mental illness also have a higher likelihood of experiencing mental health issues.26 A study in 2008 concluded that approximately 23.3 per cent of Australian children had a parent with a non-substance related mental illness.27 This can affect children in multiple ways, including experiencing a chaotic home environment, higher levels of stress and homelessness, which are all risk factors for mental health issues for the child. Protective factors, such as a supportive other parent, can buffer the effect of one parent’s mental health issues.28

Aboriginal children and young people are more likely to have mental health problems than non-Aboriginal children and young people.29 The legacy of colonisation has affected multiple generations of Aboriginal peoples.30,31 The nature of unresolved trauma and the intergenerational effects in Aboriginal communities extends ‘to all dimensions of the holistic notion of Aboriginal wellbeing, including psychological, social, spiritual and cultural aspects of life and connection to land’.32 Children and young people exposed to significant disadvantage and trauma experience far greater risk factors to their mental health – thus compounding the cycle of disadvantage.

The Western Australian Aboriginal Child Health Survey conducted in 2000 and 2001 reported that almost one quarter (24.0%) of Aboriginal children and young people aged four to 17 years were at high risk of clinically significant emotional or behavioural difficulties. This was significantly higher than the 15 per cent for WA’s general child population.33

No recent data exists on the mental health issues experienced by Aboriginal children and young people in WA.34,35

The Young Minds Matter survey could not produce estimates of mental disorders and service use for Aboriginal peoples due to the random sampling methodology and cultural issues that could not be addressed sufficiently in a national survey.36

Aboriginal adults across Australia are:

  • 1.3 times more likely to have mental health problems managed by their general practitioner
  • twice as likely to be hospitalised for mental health conditions, and
  • almost twice as likely to die by suicide as non-Aboriginal Australians.37

Research strongly suggests that around half of mental health issues in adulthood develop by the mid-teens,38 therefore investment into the prevention and early intervention of mental health issues of Aboriginal children and young people should be a high priority for government.

For further information on the mental health of Aboriginal children and young people refer to the Commissioner’s Policy Brief: The mental health and wellbeing of children and young people: Aboriginal and Torres Strait Islander children and young people.

Children and young people in the youth justice system

Children and young people in the youth justice system are also more likely to have mental health issues.39 The Banksia Hill Detention Centre is the only facility in WA for the detention of children and young people 10 to 17 years of age who have been remanded or sentenced to custody. During 2017-18, approximately 148 children and young people aged between 10 and 17 years were held in the Banksia Hill Detention Centre in WA on an average day.40

In 2017, a Telethon Kids Institute research team found that 89 per cent of young people in WA’s Banksia Hill Detention Centre had at least one form of severe neurodevelopmental impairment, while 36 per cent (36 young people) were found to have Fetal Alcohol Spectrum Disorder (FASD). While FASD is not a mental illness, it is a cognitive disability which has a significant impact on mental health and increases the likelihood of social and emotional behavioural issues that are often not diagnosed.41,42

It is of significant concern that only two of the young people with FASD had been diagnosed prior to participation in the study.43 This highlights a critical need for improved health assessment and diagnosis processes in the juvenile justice system and other services systems more broadly.

Children and young people entering youth detention have the right to be assessed to determine whether they have a physical or intellectual disability, mental health issues, learning difficulties or experience other forms of vulnerability and to have those needs met.

No other data exists on the prevalence of mental health issues for children and young people in the youth justice system in WA.

Lesbian, gay, bisexual, trans and intersex children

Lesbian, gay, bisexual, transgender and intersex (LGBTI)44 children and young people are also at an increased risk of a range of mental health problems, including depression, anxiety disorders, self-harm and suicide.45

The issues that affect LGBTI people largely stem from social and cultural beliefs and assumptions about gender and sexuality. As a result of these beliefs and social norms they have a much higher likelihood of experiencing abuse, violence and systemic discrimination at an individual, social, political and legal level than non-LGBTI people.46

Administrative data on the prevalence of self-harm behaviour for children and young people who identify as LGBTI are not available, as unlike other demographic characteristics, LGBTI status or identity is not captured in most data collections.47

Survey data has found that almost one-quarter of same-sex attracted Australians experienced a major depressive episode in 2005 and have up to 14 times higher rates of suicide attempts than their heterosexual peers.48 Furthermore, a study into the mental health of trans young people found that almost three-quarters (74.6%) of participating trans young people (aged 25 years or under) have at some point been diagnosed with depression and 72.2 per cent have been diagnosed with an anxiety disorder.49

There is no available data on the experience of mental health issues by WA young people who identify as LGBTI.

For more information on LGBTI children and young people, refer to the Commissioner’s Issues paper: Lesbian, Gay, Bisexual, Trans and Intersex (LGBTI) children and young people.

Culturally and linguistically diverse children

There is limited data on the prevalence of mental health issues for young people from culturally and linguistically diverse (CALD) backgrounds.

Data from the 2016 Census of Population and Housing shows that 17.3 per cent of 0 to 17 year-olds in WA were born in a country other than Australia and New Zealand (Oceania). The most common region of birth after Australia and New Zealand is North-West Europe (3.6%), followed by South-East Asia (2.7%) and Sub-Saharan African (1.8%).50

In WA, 17.5 per cent of people spoke a language other than English at home in 2016. Other than English, Mandarin was the most common, with 1.9 per cent of people speaking this language at home. The next most common languages were Italian, Filipino/Tagalog and Vietnamese.51

There is some evidence to suggest that children and young people from refugee and some migrant backgrounds are more likely to experience mental health problems than the general population.52 This is often as a result of significant disadvantage and trauma related to their refugee, migration and settlement experience.53,54

Some children and young people from CALD backgrounds (and their families) experience language barriers, feeling torn between cultures, intergenerational conflict, racism and discrimination, bullying and resettlement stress.55 Some of these children and young people have traumatic pre-migration experiences, including family separation, war, violence and immigration detention, which can also impact their mental health and wellbeing.

Yet, research suggests that people from CALD backgrounds often do not seek help for mental health issues. This can be for cultural reasons, because information is not available in community languages, or there is no culturally appropriate service available.56

There is no data available on the mental health of young people in WA of a CALD background.

For more information refer to the Commissioner’s policy brief:

Commissioner for Children and Young People WA 2013, The mental health and wellbeing of children and young people: Children and Young People from Culturally and Linguistically Diverse Backgrounds, Commissioner for Children and Young People WA.

Endnotes

  1. Kim-Cohen J et al 2003, Prior juvenile diagnoses in adults with mental disorder: Developmental follow-back of a prospective longitudinal cohort, Archives of General Psychiatry, Vol 60, No 7.
  2. The Commissioner recognises that Aboriginal people have a holistic view of mental health – a view that incorporates the physical, social, emotional and cultural wellbeing of individuals and their communities and the importance of connection to the land, culture, spirituality, ancestry, family and community. For more information refer to Dudgeon P et al (eds) 2014, Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice – Second edition, Australian Government.
  3. National Scientific Council on the Developing Child 2012, Establishing a Level Foundation for Life: Mental Health Begins in Early Childhood: Working Paper 6, Center on the Developing Child, Harvard University.
  4. Mission Australia and Black Dog Institute 2017, Youth mental health report: Youth Survey 2012-2016, Mission Australia.
  5. World Health Organisation (WHO) 2018, Adolescent Mental Health Fact Sheet, WHO.
  6. McGorry P et al 2014, Cultures for mental health care of young people: an Australian blueprint for reform, The Lancet Psychiatry, Vol 1.
  7. Mental Health Australia 2014, Getting the NDIS right for people with psychosocial disability, Mental Health Council of Australia.
  8. Garten A et al 1998, The Western Australian Child Health Survey: A review of what was found and what was learned, The Educational and Developmental Psychologist, Vol 15 No 1.
  9. Zubrick S et al 2005, The Western Australian Aboriginal Child Health Survey: The Social and Emotional Wellbeing of Aboriginal Children and Young People, Curtin University of Technology and Telethon Institute for Child Health Research, p. 25.
  10. Lawrence D et al 2015, The Mental Health of Children and Adolescents: Report on the second Australian child and adolescent survey of mental health and wellbeing, Department of Health, Australian Goverment, p. 146.
  11. The Diagnostic Interview Schedule for Children Version IV (DISC-IV) is a validated tool for identifying mental disorders in children and adolescents according to criteria specified in the Diagnostic and Statistical Manual for Mental Disorders Version IV (DSM-IV). Source: Lawrence D et al 2015, The Mental Health of Children and Adolescents: Report on the second Australian child and adolescent survey of mental health and wellbeing, Department of Health, Australia Government, p. 23.
  12. Lawrence D et al 2015, The Mental Health of Children and Adolescents: Report on the second Australian child and adolescent survey of mental health and wellbeing, Department of Health, Australian Government, p. 18.
  13. Lawrence D et al 2015, The Mental Health of Children and Adolescents: Report on the second Australian child and adolescent survey of mental health and wellbeing, Department of Health, Australian Government.
  14. Quinn P 2015, Treating adolescent girls and women with ADHD: Gender-specific issues, Journal of Clinical Psychology, Vol 61, No 5.  
  15. Walters A 2018, Girls with ADHD: Underdiagnosed and untreated, The Brown University Child and Adolescent Behavior Letter, Vol 34, No 11.
  16. The WA Department of Health’s, Health and Wellbeing Surveillance System is a continuous data collection which was initiated in 2002 to monitor the health status of the general population. In 2017, 780 parents/carers of children aged 0 to 15 years were randomly sampled and completed a computer assisted telephone interview between January and December, reflecting an average participation rate of just over 90 per cent. The sample was then weighted to reflect the Western Australian child population.
  17. Custom report provided to the Commissioner for Children and Young People WA by the WA Department of Health Epidemiology Branch, Selected risk factor estimates for WA children using the WA Health and Wellbeing Surveillance System, 2009-2016 [unpublished]. Results from WA Children’s Health and Wellbeing Survey where parents were asked whether a doctor had ever told them that their child has Attention Deficit Hyperactivity Disorder.
  18. This data has been sourced from individual annual Health and Wellbeing Surveillance System reports and therefore has not been adjusted for changes in the age and sex structure of the population across these years nor any change in the way the question was asked. No modelling or analysis has been carried out to determine if there is a trend component to the data, therefore any observations made are only descriptive and are not statistical inferences.
  19. Lawrence D et al 2015, The Mental Health of Children and Adolescents: Report on the second Australian child and adolescent survey of mental health and wellbeing, Department of Health, Australian Government, p. 81.
  20. Johnson S et al 2018, Mental disorders in Australian 4- to 17- year olds: Parent-reported need for help, Australian & New Zealand Journal of Psychiatry, Vol 52, No 2.
  21. Ibid.
  22. Lawrence D et al 2015, The Mental Health of Children and Adolescents: Report on the second Australian child and adolescent survey of mental health and wellbeing, Department of Health, Australian Government, p. 26.
  23. Enticott J et al 2016, Mental disorders and distress: Associations with demographics, remoteness and socioeconomic deprivation of area of residence across Australia, Australian & New Zealand Journal of Psychiatry, Vol 50 No 12.
  24. Lawrence D et al 2015, The Mental Health of Children and Adolescents: Report on the second Australian child and adolescent survey of mental health and wellbeing, Department of Health, Australian Government, p. 26.
  25. Ivancic L et al 2018, Lifting the weight: Understanding young people’s mental health and service needs in regional and remote Australia, ReachOut Australia and Mission Australia.
  26. Mowbray C et al 2006, Psychosocial outcomes for adult children of parents with severe mental illnesses: demographic and clinical history predictors, Health and Social Work, Vol 31.
  27. Maybery D et al 2009, Prevalence of parental mental illness in Australian families, Psychiatric Bulletin, Vol 33.
  28. Reupert D et al 2013, Children whose parents have a mental illness: prevalence, need and treatment, The Medical Journal of Australia, Vol 199, No 3 supplement.
  29. Zubrick SR et al 2005, The Western Australian Aboriginal Child Health Survey: The Social and Emotional Wellbeing of Aboriginal Children and Young People, Curtin University of Technology and Telethon Institute for Child Health Research, p. 25.
  30. Human Rights and Equal Opportunity Commission 1997, Bringing them home: Report of the National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from Their Families, Australian Government.
  31. Atkinson J 2013, Trauma-informed services and trauma-specific care for Indigenous Australian children: Resource sheet no 21 produced for Closing the Gap Clearinghouse, Australian Institute of Health and Welfare and Australian Institute of Family Studies.
  32. Zubrick SR et al 2014, Chapter 6: Social Determinants of Social and Emotional Wellbeing, in Dudgeon P et al 2014, Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice, Telethon Institute for Child Health Research/Kulunga Research Network, p. 99.
  33. Zubrick SR et al 2005, The Western Australian Aboriginal Child Health Survey: The Social and Emotional Wellbeing of Aboriginal Children and Young People, Curtin University of Technology and Telethon Institute for Child Health Research, p. 25.
  34. The Young Minds Matter survey could not produce estimates of mental disorders and service use for Aboriginal peoples due to the random sampling methodology and cultural issues that could not be addressed sufficiently in a national survey (p. 146). Similarly, the ReachOut and Mission Australia survey of young people’s mental health in regional and remote areas were unable to recruit sufficient numbers of young people who identified as Aboriginal and/or Torres Strait Islander to be able to examine the experiences and needs of this group separately (p. 11).
  35. Ivancic L et al 2018, Lifting the weight: Understanding young people’s mental health and service needs in regional and remote Australia, ReachOut Australia and Mission Australia, p. 11.
  36. Lawrence D et al 2015, The Mental Health of Children and Adolescents: Report on the second Australian child and adolescent survey of mental health and wellbeing, Department of Health, Australian Government, p. 146.
  37. Australian Institute of Health and Welfare (AIHW) 2015, The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015, Cat No IHW 147, AIHW, p. 80.
  38. Kessler RC et al 2005, Lifetime prevalence and age of onset distributions of DSM-IV Disorders in the National Comorbidity Survey replicationArchives of General Psychiatry, Vol 62, p 1.
  39. Justice Health & Forensic Mental Health Network and Juvenile Justice NSW 2015, 2015 Young People in Custody Health Survey: Full Report, NSW Government, p. 65.
  40. WA Department of Justice 2018, Annual Report: 2017-18, WA Government, p. 15.
  41. Brown J et al 2018, Fetal Alcohol spectrum disorder (FASD): A beginner’s guide for mental health professionals, Journal of Neurological Clinical Neuroscience, Vol 2, No 1.
  42. Pei J et al 2011, Mental health issues in fetal alcohol spectrum disorder, Journal Of Mental Health, Vol 20, No 5.
  43. Bower C et al 2018, Fetal alcohol spectrum disorder and youth justice: a prevalence study amount young people sentenced to detention in Western Australia, BMJ Open, Vol 8, No 2.
  44. The Commissioner for Children and Young People understands there are a range of terms and definitions that people use to define their gender or sexuality. The Commissioner’s office will use the broad term LGBTI to inclusively refer to all people who are lesbian, gay, bisexual, trans and intersex, as well as to represent other members of the community that use different terms to describe their diverse sexuality and/or gender.
  45. Leonard W et al 2012, Private Lives 2: The second national survey of the health and wellbeing of gay,lesbian, bisexual and transgender (GLBT) Australians, Monograph Series Number 86, The Australian Research Centre in Sex, Health & Society, La Trobe University.
  46. Rosenstreich G 2013, LGBTI People Mental Health and Suicide, Revised 2nd Edition, National LGBTI Health Alliance, p. 4.
  47. Ombudsman Western Australia 2014, Investigation into ways that State government departments and authorities can prevent or reduce suicide by young people, WA Government, p. 35.
  48. Rosenstreich G 2013, LGBTI People Mental Health and Suicide, Revised 2nd Edition, National LGBTI Health Alliance, p. 3.
  49. Strauss P 2017, Trans Pathways: the mental health experiences and care pathways of trans young people, Telethon Kids Institute, p. 10.
  50. Australian Bureau of Statistics (ABS) 2019, Census of Population and Housing, 2016, TableBuilder – Dataset 2016 Census – Cultural Diversity, ABS.
  51. .id the population experts, Western Australia Community Profile – Language Spoken at Home [website], sourced from the ABS 2016 Census.
  52. De Anstiss H and Ziaian T 2010, Mental health help-seeking and refugee adolescents: Qualitative findings from a mixed-methods investigation, Australian Psychologist, Vol 45, No 1.
  53. Fazel M and Stein R 2002, The mental health of refugee children, Archives of disease in childhood, Vol 87.
  54. Francis S and Cornfoot S 2007, Multicultural youth in Australia: Settlement and transition, Centre for Multicultural Youth Issues for the Australian Research Alliance for Children and Youth,
  55. WA Office of Multicultural Interests 2009, Not drowning, waving: Culturally and linguistically diverse young people at risk in Western Australia, WA Government, p. 5.
  56. Australian Department of Health, Fact Sheet 20: Suicide prevention and people from culturally and linguistically diverse (CALD) backgrounds, Australian Government.
Measure: Receiving services for mental health issues

Providing services for mental health issues early in a young person’s life not only reduces individual suffering, but can also produce long-term cost savings to the government and the community.1,2

Yet, the Commissioner’s 2011 Inquiry into the mental health and wellbeing of children and young people in Western Australia and the follow up “Our Children Can’t Wait” report found there has been significant underfunding of mental health services for WA children and young people relative to the funding received by adult mental health services, as well as relative to need.

Many young people with mental health issues will not access mental health services. This is for a number of reasons including stigma around seeking help, concerns about confidentiality, limited availability of affordable and age-appropriate services particularly in regional and remote locations and a low level of parental and community awareness regarding the importance of supporting young people’s mental health by accessing appropriate services.3

Therefore, the administrative data in this measure will underrepresent the extent of mental health problems experienced by young people in the community. However, it does provide some information on service use by WA young people.

Administrative data from the WA Department of Health’s Hospital Morbidity Data Collection provides data on hospital separations4 for children and young people with mental health issues. It also provides information on the number of children and young people who received services from public child and adolescent community mental health services.

Young people aged 13 to 17 years who separated from a public or private hospital with a mental health condition, number and age-specific rate, WA, 2012 to 2017

Number

Age-specific rate

2012

1,171

148.1

2013

1,124

142.7

2014

933

118.7

2015

891

114.0

2016

879

111.7

2017

1,023

n/a

Source: Custom report from the WA Department of Health, Hospital Morbidity Data Collection provided to the Commissioner for Children and Young People WA [unpublished]

n/a - rate is not available for 2017 at time of publication.

Notes:

1. Figures only include patients who were diagnosed with ICD-10-AM Primary Diagnosis Code of Mental Health or discharged from a designated psychiatric ward.

2. Age Group is based on patient's age at the time of admission into hospital

3. Figures are subject to change.

4. Age-specific rate is the number of separations for an age group divided by the population for the age group, expressed as per 100,000 population.

In 2017, 1,023 WA young people aged 13 to 17 years separated from a WA public or private hospital with a principal diagnosis of a mental health condition. The top three principal diagnoses were borderline personality disorder, severe depressive episode without psychotic symptoms and anorexia nervosa.5

From 2012 to 2016 there was a reduction in the age-specific rate of separations from hospital with a mental health diagnosis for WA young people aged 13 to 17 years. The rate for 2017 is not yet available.

The table below highlights the increase in service-use as children age, in particular as they enter adolescence.

Rates of mental-health related separations from public or private hospitals among children and young people by selected age groups, age-specific rate, WA, 2012 to 2016

0 to 4 years

5 to 12 years

13 to 17 years

2012

3.5

8.6

148.1

2013

4.0

7.5

142.7

2014

3.5

8.1

118.7

2015

3.7

7.8

114.0

2016

5.8

8.3

111.7

Total

4.1

8.1

127.1

Source: Custom report from the WA Department of Health, Hospital Morbidity Data Collection provided to the Commissioner for Children and Young People WA [unpublished]

Notes:

1. Figures only include patients who were diagnosed with ICD-10-AM Primary Diagnosis Code of Mental Health (F-code) or discharged from a designated psychiatric hospital/ward.

2. Age-specific rate (ASPR) is the number of separations for an age group divided by the population for the age group, expressed as per 100,000 population.

Rates of mental-health related separations from public or private hospitals among children and young people by selected age groups, age-specific rate, WA, 2012 to 2016

Source: Custom report from the WA Department of Health, Hospital Morbidity Data Collection provided to the Commissioner for Children and Young People WA [unpublished]

Rates of mental health hospital separations continue to increase until middle age, with the Australian Institute of Health and Welfare reporting that the rate for overnight admitted mental health separations with specialised care is 55 per 100,000 for Australian young people under 15 years of age and 940 per 100,000 for young people aged 15 to 24 years. In comparison, Australian adults aged 35 to 44 years have the highest rate of overnight admitted mental health separations with specialised care at 1,082 per 100,000 people.6

Young people aged 13 to 17 years separating from a WA hospital are most likely to be diagnosed with a personality disorder or depression and anorexia is the third most common disorder.7  

The reduction in mental health hospital separations from 2013 to 2016 could be due to a variety of reasons including better targeted mental health services reducing the need for hospital admittance or a reduction in accessibility of hospital beds and services.

Young people living in regional and remote areas are more likely to be discharged from a hospital with a mental health diagnosis than young people living in the metropolitan area.

Young people aged 13 to 17 years who separated from public or private hospitals for a mental health condition by region, number, WA, 2012 to 2017

Metropolitan

Non-metropolitan

Total*

2012

832

319

1,171

2013

761

348

1,124

2014

623

299

933

2015

637

249

891

2016

628

240

879

2017

757

253

1,023

Total (2012-2017)

4,238

1,708

6,021

Source: Custom report from the WA Department of Health, Hospital Morbidity Data Collection provided to the Commissioner for Children and Young People WA [unpublished]

* Totals do not sum as total includes where patient’s residential address was unknown, no fixed permanent address or residence outside Australia.

Note: Figures only include patients who were diagnosed with ICD-10-AM Primary Diagnosis Code of Mental Health (F-code) or discharged from a designated psychiatric hospital/ward.

Age-specific rates for this age group by region are not available, however for children and young people aged 0 to 17 years the rate of separations from hospital with a mental health diagnosis is significantly higher in outer regional and remote areas than in the metropolitan area and inner regional.

Rates of mental-health related separations from public or private hospitals among children and young people aged 0 to 17 years by year and remoteness area, age-adjusted rate, WA, 2012 to 2016

Metropolitan

Inner regional

Outer regional

Remote

Very remote

2012

44.4

39.3

52.4

89.9

70.4

2013

40.4

40.9

68.2

87.8

59.3

2014

34.5

28.9

59.3

83.4

57.1

2015

35.1

32.4

57.7

39.6

38.8

2016

35.3

36.1

45.2

43.1

51.7

Total

38.0

35.5

56.6

68.7

55.4

Source: Custom report from the WA Department of Health, Hospital Morbidity Data Collection provided to the Commissioner for Children and Young People WA [unpublished]

Notes:

1. Figures only include patients who were diagnosed with ICD-10-AM Primary Diagnosis Code of Mental Health or discharged from a designated psychiatric ward.

2. Age-adjusted rate per 100,000 population. Direct standardisation using all age groups of 2001 Australian Standard Population in order to compare rates between population groups and different years for the same population group.

Rates of mental-health related separations from public or private hospitals among children and young people aged 0 to 17 years by year and remoteness area, age-adjusted rate, WA, 2012 to 2016

Source: Custom report from the WA Department of Health, Hospital Morbidity Data Collection provided to the Commissioner for Children and Young People WA [unpublished]

There has been a substantial reduction in the rate of mental-health related separations in remote and very remote regions from 2012 to 2016. This will continue to be monitored to determine if this is an ongoing trend.

There are multiple factors that can result in a lower rate of children and young people being discharged from hospital with a mental health diagnosis. This can include initiatives to address mental health issues earlier through community-based services, avoiding the need for a hospital stay. However, a reduction in the rate of separations, does not necessarily mean a reduction in need – it could also be a reduction in service availability.

For example, the Australian Institute of Health and Welfare report on hospital resources shows that the average available number of public hospital beds per 1,000 population in WA was 2.31 in 2017-18.8 This was the lowest number of beds per 1,000 population of all states and territories (excluding the Northern Territory which did not provide the number of beds for all hospitals).

It should be noted that the Perth Children’s Hospital opened in 2018 with a mental health inpatient unit comprising a 14-bed acute section for children and adolescents who require a high level of assessment, monitoring and treatment and six beds for those who require less support and supervision during their treatment and recovery.9

Young people aged 13 to 17 years who separated from a WA public or private hospital with a mental health condition by sex*, number and age-specific rate, WA, 2012 to 2017

Male

Female

Number

Age-specific rate

Number

Age-specific rate

2012

365

91.5

785

196.8

2013

338

84.7

770

193.0

2014

261

65.4

660

165.4

2015

274

68.7

605

151.6

2016

248

62.2

611

153.2

2017

307

n/a

697

n/a

Source: Custom report from the WA Department of Health, Hospital Morbidity Data Collection provided to the Commissioner for Children and Young People WA [unpublished]

n/a - rate is not available for 2017 at time of publication.

* The Hospital Morbidity Data Collection does not capture data on gender but biological sex (male/female).

Notes:

1. Figures only include patients who were diagnosed with ICD-10-AM Primary Diagnosis Code of Mental Health (F-code) or discharged from a designated psychiatric hospital/ward.

2. Age-specific rate (ASPR) is the number of separations for an age group divided by the population for the age group, expressed as per 100,000 population.

Female young people aged 13 to 17 years in WA are significantly more likely to separate from a hospital for mental health issues than male young people of the same age group. WA male and female children under 13 years of age have similar rates of separation from a hospital with a mental health diagnosis (refer to the Mental Health Indicator for age group: 6 to 11 years), therefore this represents a significant shift for female young people in adolescence.

This aligns with the data from the Mission Australia survey which highlights that WA female young people (aged 15 to 19 years) are more likely to be concerned about issues such as coping with stress and mental health, and are less likely to describe themselves as happy or positive about the future (refer to Measure: Positive outlook on life).

The WA Department of Health also collects data on the number of WA children and young people who receive services from public child and adolescent community mental health services.

This data only includes public mental health service provision, including outpatient and community mental health services. The public mental health system typically provides services to people with moderate to severe mental health issues, whereas people with mild or emerging mental health issues are often supported by community organisations, support services or primary health providers, for example, general practitioners, counsellors, private practitioners or services such as headspace.

Service contacts at public child and adolescent community mental health services among young people aged 13 to 17 years, number and age-specific rate, WA, 2012 to 2017

Number

Age-specific rate

2012

4,260

599.1

2013

4,992

686.5

2014

5,069

670.9

2015

4,796

620.3

2016

5,145

648.7

2017

5,711

n/a

Source: Custom report from the WA Department of Health, Mental Health Data Collection provided to the Commissioner for Children and Young People WA [unpublished]

n/a - rate is not available for 2017 at time of publication.

Note: Age-specific rate is the number of service contacts for an age group divided by the population for the age group, expressed as per 100,000 population.

In 2016, the age-specific rate service contacts for young people aged 13 to 17 years increased from the previous year (648.7 per 100,000 in 2016 compared to 620.3 per 100,000 in 2015).

Rate of service contacts at public child and adolescent community mental health services among children and young people by selected age groups, age-specific rate, WA, 2012 to 2016

0 to 4 years

5 to 12 years

13 to 17 years

2012

36.4

246.2

599.1

2013

36.4

244.5

686.5

2014

33.3

232.4

670.9

2015

30.7

228.2

620.3

2016

35.2

257.2

648.7

Total

34.4

241.7

645.1

Source: Custom report from the WA Department of Health, Mental Health Data Collection provided to the Commissioner for Children and Young People WA [unpublished]

Note: Age-specific rate is the number of service contacts for an age group divided by the population for the age group, expressed as per 100,000 population.

Rate of service contacts at public child and adolescent community mental health services among children and young people by selected age groups, age-specific rate, WA, 2012 to 2016

Source: Custom report from the WA Department of Health, Mental Health Data Collection provided to the Commissioner for Children and Young People WA [unpublished]

The age-specific rate of service contacts at public mental health community services for children aged five to 12 years (257.2 per 100,000 in 2016) is significantly lower than the age-specific rate of public mental health community service contacts for children aged 13 to 17 years (648.7 per 100,000 in 2016). This highlights an increase in service-use as children age, in particular as they enter adolescence.

This increase could be related to higher need or severity of mental health issues as children get older and enter adolescence, particularly if their mental health issues have not been identified and addressed at an earlier stage. This could also be influenced by the lack of community awareness and identification of mental health issues in young children and also public service availability for that younger age group.

The age-specific rate of mental-health related service contacts for young people aged 13 to 17 years in WA has fluctuated from 2012 to 2016 with no clear trend.

Young people aged 13 to 17 years who received services from a public child and adolescent community mental health service by sex, number and age-specific rate, WA, 2012 to 2017

Male

Female

Number

Age-specific rate

Number

Age-specific rate

2012

1,878

470.7

2,739

686.6

2013

2,052

514.4

3,272

820.2

2014

2,111

529.1

3,282

822.7

2015

2,012

504.3

3,083

772.8

2016

2,133

534.7

3,327

833.9

2017

2,350

n/a

3,715

n/a

Source: Custom report from the WA Department of Health, Mental Health Information System provided to the Commissioner for Children and Young People WA [unpublished]

Note: Age-specific rate is the number of service contacts for an age group divided by the population for the age group, expressed as per 100,000 population.

n/a - rate is not available for 2017 at time of publication.

Over the five years from 2012 to 2016, female young people aged 13 to 17 years had a much higher age-specific rate of contact with public mental health services (833.9 per 100,000 in 2016) than male young people aged 13 to 17 years (534.7 per 100,000 in 2016).

This represents a substantial shift from the younger age group where male children aged five to 12 years had higher rates of service than female children (311.1 compared to 189.3 from 2012 to 2016, respectively).

Rate of service contacts at public child and adolescent community mental health services among children and young people by selected age groups and sex, age-specific rate, WA, 2012 to 2016

5 to 12 years

13 to 17 years

Male

Female

Male

Female

2012

310.0

171.3

470.7

686.6

2013

306.3

174.3

514.4

820.2

2014

299.9

176.7

529.1

822.7

2015

305.4

173.4

504.3

772.8

2016

334.0

214.4

534.7

833.9

Total

311.1

189.3

510.6

830.8

Source: Custom report from the WA Department of Health, Mental Health Information System provided to the Commissioner for Children and Young People WA [unpublished]

Note: Age-specific rate is the number of service contacts for an age group divided by the population for the age group, expressed as per 100,000 population.

Rate of service contacts at public child and adolescent community mental health services among children and young people by selected age groups and sex, age-specific rate, WA, 2012 to 2016

Source: Custom report from the WA Department of Health, Mental Health Information System provided to the Commissioner for Children and Young People WA [unpublished]

Research suggests that there are multiple factors influencing the differences between male and female children and young people experiencing mental health issues and receiving mental health services, including:

  • Male children and young people are more likely to display ‘externalising’ behaviours and problems with attention, self-regulation or antisocial behaviour, while female children and young people are ‘prone to symptoms that are directed inwardly’ or internalising behaviours, including depression, withdrawal, feelings of inferiority or shyness.10 These internalising behaviours may be less noticeable or recognisable than externalising behaviours, and therefore may not result in referral for services.
  • Male young people are less likely to seek help, often due to social pressure, stigma,11 wanting to keep their problems to themselves, or feeling that they don’t have anyone to talk to.12
  • Female young people are more likely to experience anxiety and depression due to social norms regarding gender roles (including body-image) and also a higher likelihood of experiencing gender-based violence and abuse.13

Children and young people in remote, very remote and outer regional areas have a consistently higher rate of accessing public mental health services than children and young people in the inner regional and metropolitan areas.

Rates of service contacts at public child and adolescent community mental health services among children and young people aged 0 to 17 years by year and remoteness area, age-adjusted rate, WA, 2012 to 2016

Metropolitan

Inner regional

Outer regional

Remote

Very remote

2012

242.0

271.9

487.5

721.4

494.5

2013

262.2

279.4

510.3

855.3

557.6

2014

254.8

278.9

507.2

755.3

515.4

2015

245.3

280.3

442.6

666.9

462.7

2016

263.8

312.9

451.7

698.9

565.4

Total

253.6

284.7

479.9

739.6

519.1

Source: Custom report from the WA Department of Health, Mental Health Information System provided to the Commissioner for Children and Young People WA [unpublished]

Note: Age-adjusted rate per 100,000 population. Direct standardisation using all age groups of 2001 Australian Standard Population in order to compare rates between population groups and different years for the same population group.

Rates of service contacts at public child and adolescent community mental health services among children and young people aged 0 to 17 years by year and remoteness area, age-adjusted rate, WA, 2012 to 2016

Source: Custom report from the WA Department of Health, Mental Health Information System provided to the Commissioner for Children and Young People WA [unpublished]

From 2013 to 2015 there was a reduction in the age-adjusted rate of children and young people accessing public mental health services in the outer regional and remote areas of WA. In 2016, the age-adjusted rate increased across all areas of WA.

Data of this nature should be considered with caution. A measure of mental health service use is not a measure of prevalence of mental health issues in a population. In particular, one young person may have had multiple service contacts. Furthermore, the reasons for changes in the rate of accessing mental health services can be varied. It could be due to a lower proportion of children and young people experiencing mental health problems and a commensurate decrease in the number of services. Alternatively, a reduction in the rate of service could be related to issues with accessibility of the services, such that children and young people have a mental health issue but are unable to access an appropriate service in their area.

Australian research analysing Medicare data from 1 July 2007 to 30 June 2011 for mental health services found that increasing remoteness and socioeconomic disadvantage were associated with lower service activity.14

Children in remote and regional areas receive public mental health services at a higher rate than children and young people in the metropolitan area. This is partly because there are fewer non-public mental health services or professionals available in remote and regional locations communities.15,16 However, data also suggests that children and young people in remote and regional locations have a much higher likelihood of experiencing mental health issues.17 This is for a variety of reasons including socio-economic disadvantage, isolation, greater misuse of drugs and alcohol and concerns about finding work in the future.18,19

Research suggests that even with the higher rates of receiving public services in remote and regional areas there is a still a significant unmet need for children and young people in these regions.20

WA Aboriginal young people aged 13 to 17 years are much more likely to receive public mental health services than non-Aboriginal children in this age group (1,357.3 per 100,000 Aboriginal young people in 2016 compared to 644.4 per 100,000 non-Aboriginal young people).

Rates of service contacts at public child and adolescent community mental health services among children and young people by selected age groups and Aboriginal status, age-specific rate, WA, 2012 to 2016

5 to 12 years

13 to 17 years

Aboriginal

Non-Aboriginal

Aboriginal

Non-Aboriginal

2012

481.1

217.7

904.8

545.9

2013

504.0

216.0

1,169.4

613.6

2014

485.9

217.9

1,131.1

634.5

2015

493.2

221.5

1,199.7

602.5

2016

560.7

254.7

1,357.3

644.4

Total (2012-2016)

505.0

225.6

1,152.5

608.2

Source: Custom report from the WA Department of Health, Mental Health Information System provided to the Commissioner for Children and Young People WA [unpublished]

Note: Age-specific rate (ASPR) is the number of service contacts for an age group divided by the population for the age group, expressed as per 100,000 population.

Rates of service contacts at public child and adolescent community mental health services among children and young people by selected age groups and Aboriginal status, age-specific rate, WA, 2012 to 2016

Source: Custom report from the WA Department of Health, Mental Health Information System provided to the Commissioner for Children and Young People WA [unpublished]

There has been a trend towards an increasing rate of young people receiving public services for mental health issues, particularly young Aboriginal people aged 13 to 17 years. It should be noted that this data only reports the rate of children and young people receiving mental health services. It does not document the prevalence of mental health issues in these populations.

Aboriginal children and young people are more likely to be living in regional and remote areas of WA and research highlights that for many Aboriginal people (children and adults) mental health services are often not accessible, due to geographic distance and/or because they are not culturally appropriate.21,22 It is therefore possible that this data under-estimates the gap between Aboriginal and non-Aboriginal children who require mental health services.

The 2019 WA State Coroner’s report, Inquest into the deaths of: Thirteen children and young persons in the Kimberley region, Western Australia, highlighted that most of the children and young people had previously voiced suicidal ideation or intent, but with the exception of one child, none had been directed to a primary health service or mental health service.23 In this regard, the Coroner recommended that the Department of Communities’ child protection workers and school teaching staff in the Kimberley who have regular contact with Aboriginal children receive appropriate training in suicide intervention and prevention, and that such training be provided at appropriately regular intervals (Recommendation 20).24

Young people in the youth justice system

Young people in the youth justice system are more likely to have mental health issues than other young people.25 The Banksia Hill Detention Centre is the only facility in WA for the detention of children and young people 10 to 17 years of age who have been remanded or sentenced to custody. During 2017-18, approximately 148 children and young people aged between 10 and 17 years were held in the Banksia Hill Detention Centre in WA on an average day.26

In their 2017 inspection of the Banksia Hill facility, the Officer of the Inspector of Custodial Services noted that the mental health crisis care facilities were not adequate and “created a highly inappropriate and counter-therapeutic environment to house young people who are, or had been acutely mentally unwell”.27 They also noted that, contrary to policy, less than one-third of behaviour management plans had involved consultations with a psychologist.28

Lesbian, gay, bisexual, trans and intersex children

Lesbian, gay, bisexual, trans and intersex (LGBTI) children and young people have a very high risk of mental health problems, including depression, anxiety, self-harm and suicidal thought.29 Yet, administrative data on children and young people who identify as LGBTI receiving services for mental health issues are not available, as unlike other demographic characteristics LGBTI status or identity is often not captured in most data collections.30

Research has found that LGBTI children and young people may delay seeking treatment in the expectation that they will be subject to discrimination or receive reduced quality of care.31

There is no available data on the experience of mental health issues or services received by young people in WA who identify as LGBTI.

For more information refer to the Commissioner’s issues paper:

Commissioner for Children and Young People WA 2019, Issues Paper: Lesbian, Gay, Bisexual, Trans and Intersex (LGBTI) children and young people, Commissioner for Children and Young People WA.

Culturally and linguistically diverse children

There is evidence to suggest that children and young people from refugee and some migrant backgrounds are more likely to experience mental health problems than the general population.32 Some children and young people from CALD backgrounds (and their families) experience language barriers, feeling torn between cultures, intergenerational conflict, racism and discrimination, bullying and resettlement stress.33

Data and research also suggests that people from culturally and linguistically diverse (CALD) backgrounds often do not seek help for mental health issues. The Australian Bureau of Statistics reports that while eight per cent of people born in Australia who speak English at home accessed mental health related services in 2011, only 5.6 per cent of people who were born overseas and speak a language other than English at home accessed these services.34

Research has found the lack of service use can be for cultural reasons, because information is not available in community languages, or there is no culturally appropriate service available.35

There is no available data on the experience of mental health issues or services received by children and young people in WA of a CALD background.

For more information refer to the Commissioner’s policy brief:

Commissioner for Children and Young People WA 2013, The mental health and wellbeing of children and young people: Children and Young People from Culturally and Linguistically Diverse Backgrounds, Commissioner for Children and Young People WA.

Endnotes

  1. Access Economics 2009, The economic impact of youth mental illness and the cost effectiveness of early intervention, p. iii-iv.
  2. British Medical Association (BMA) 2017, Exploring the cost effectiveness of early intervention and prevention, BMA, p. 7.
  3. Commissioner for Children and Young People WA 2015, Our Children Can’t Wait – Review of the implementation of recommendations of the 2011 Report of the Inquiry into the mental health and wellbeing of children and young people in WA, Commissioner for Children and Young People WA.
  4. Hospital separation means the process by which an admitted patient completes an episode of care either by being discharged, dying, transferring to another hospital or changing type of care. Source: Australian Institute of Health and Welfare 2017, Admitted patient care 2015–16: Australian hospital statistics, Health services series no 75, Cat no HSE 185, AIHW p. 282.
  5. Custom report provided by the Department of Health to the Commissioner for Children and Young People WA on the top diagnoses of children and young people separating from a WA public or private hospital with a mental health diagnosis or discharged from a mental health inpatient unit.
  6. Australian Institute of Health and Welfare (AIHW) 2019, Mental Health Services in Australia – Data table for overnight admitted mental health related care, AIHW.
  7. Custom report provided by the Department of Health to the Commissioner for Children and Young People WA on the top diagnoses of children and young people separating from a WA public or private hospital with a mental health diagnosis or discharged from a mental health inpatient unit.
  8. Australian Institute of Health and Welfare (AIHW) 2019, Hospital resources 2017–18: Australian hospital statistics: Table 4.9: Average available beds(a) and beds per 1,000 population, public hospitals, states and territories, 2013–14 to 2017–18, Health services series No 78 Cat No HSE 190, AIHW.
  9. WA Department of Health 2019, Perth Children’s Hospital Mental Health, WA Government.
  10. World Health Organisations (WHO) 2002, Gender and Mental Health, WHO.
  11. Chandra et al 2006, Stigma starts early: Gender differences in teen willingness to use mental health services, Journal of Adolescent Health, Vol 38.
  12. Commissioner for Children and Young People WA 2010, Speaking out about wellbeing: The views of Western Australian children and young people, Commissioner for Children and Young People WA, p. 22
  13. World Health Organisations (WHO) 2002, Gender and Mental Health, WHO.
  14. Meadows et al 2014, Better access to mental health care and the failure of the Medicare principle of universality, Medical Journal of Australia, Vol 202, No 4.
  15. Australian Institute of Health and Welfare (AIHW) 2018, Mental Health Services in Australia: Mental Health Workforce, AIHW.
  16. Rural Doctors Association of Australia (RDAA) 2018, Submission to the Senate Community Affairs References Committee Inquiry into the Accessibility and quality of mental health services in rural and remote Australia, RDAA.
  17. Lawrence D et al 2015, The Mental Health of Children and Adolescents: Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing, Department of Health, p. 28
  18. Enticott J et al 2016, Mental disorders and distress: Associations with demographics, remoteness and socioeconomic deprivation of area of residence across Australia, Australian & New Zealand Journal of Psychiatry, Vol 50 No 12.
  19. Ivancic L et al 2018, Lifting the weight: Understanding young people’s mental health and service needs in regional and remote Australia, ReachOut Australia and Mission Australia.
  20. Ibid, p. 39.
  21. Commissioner for Children and Young People WA 2015, Our Children Can’t Wait – Review of the implementation of recommendations of the 2011 Report of the Inquiry into the mental health and wellbeing of children and young people in WA, Commissioner for Children and Young People WA, p. 35.
  22. Walker R et al 2014, Cultural Competence –Transforming Policy, Services, Programs and Practice in Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice, Dudgeon P et al (Ed), Telethon Institute for Child Health Research/Kulunga Research Network, p. 200.
  23. WA State Coroner 2019, Inquest into the deaths of: Thirteen children and young persons in the Kimberley region, Western Australia, WA Government, p. 8.
  24. Ibid, p. 319.
  25. Justice Health & Forensic Mental Health Network and Juvenile Justice NSW 2015, 2015 Young People in Custody Health Survey: Full Report, NSW Government, p. 65.
  26. WA Department of Justice 2018, Annual Report: 2017-18, WA Government, p. 15.
  27. Office of the Inspector of Custodial Services 2018, 2017 Inspection of Banksia Hill Detention Centre, WA Government, p. 53.
  28. Ibid, p. 41.
  29. Morris S 2016, Snapshot of Mental Health and Suicide Prevention Statistics for LGBTI People and Communities, National LGBTI Health Alliance.
  30. Ombudsman Western Australia 2014, Investigation into ways that State government departments and authorities can prevent or reduce suicide by young people, WA Government, p. 35.
  31. Leonard W et al 2012, Private Lives 2: The second national survey of the health and wellbeing of gay, lesbian, bisexual and transgender (GLBT) Australians, Monograph Series Number 86, The Australian Research Centre in Sex, Health & Society, La Trobe University.
  32. De Anstiss H and Ziaian T 2010, Mental health help-seeking and refugee adolescents: Qualitative findings from a mixed-methods investigation, Australian Psychologist, Vol 45, No 1.
  33. WA Office of Multicultural Interests 2009, Not drowning, waving: Culturally and linguistically diverse young people at risk in Western Australia, p. 5.
  34. Australian Bureau of Statistics (ABS) 2016, 4329.0.00.001 - Cultural and Linguistic Characteristics of People Using Mental Health Services and Prescription Medications: 2011, ABS.
  35. Australian Department of Health, Fact Sheet 20: Suicide prevention and people from culturally and linguistically diverse (CALD) backgrounds, Australian Government.
Measure: Intentional self-harm

The content for this measure considers rates of suicide and self-harm in children and young people which can be distressing. If you or anyone you know needs urgent help please contact Lifeline on 13 11 14 or the Kids Helpline on 1800 55 1800. Support is also available through headspace and beyond blue.

Intentional self-harm refers to the deliberate infliction of injury or harm on the body. In the majority of cases it is not intended to be fatal and is not an attempt at suicide.1 Data and research shows that the age of onset of self-harm in some children and young people is usually between 11 and 15 years, while for suicidal behaviour it is between 15 and 17 years.2

Children and young people may self-harm for a number of reasons including experiences of depressive and/or anxiety disorders, a crisis or difficult life event (e.g. the death of a loved one) and experiences of trauma, bullying and abuse.3,4 The most common methods of self-harm for young people is cutting followed by preventing wounds from healing, head-banging and poisoning.5

Most young people who engage in self-harming behaviours hide their injuries, therefore estimates of prevalence are problematic.6 Administrative data collected on self-harm generally reports on the number of people who were admitted to hospital as a result of injury due to intentional self-harm. Research indicates that the vast majority of children and young people who self-harm do not present for hospital treatment,7 therefore the data in this measure will underrepresent the actual number of young people intentionally self-harming.

The Australian Institute of Health and Welfare published Trends in hospitalised injury in 2018, which includes information on patients who were admitted to hospital as a result of injury due to intentional self-harm. They report that in 2014-15, the age-specific rate of hospitalisations due to intentional self-harm for Australian children and young people aged 0 to 14 years was 22.3 (per 100,000).8 This increases to 325.4 per 100,000 for young people aged 15 to 19 years.9 

In contrast, the Young Minds Matter survey (2015) found that around one in 10 young people (aged 12 to 17 years) reported having ever self-harmed.10 This higher rate of self-harm reflects the proportion of young people self-harming without necessarily attending hospital. This survey also found that only 57.6 per cent of young people who had self-harmed more than four times at any time in the past had used services for emotional or behavioural problems in the previous 12 months.11  

The WA Department of Health has provided the Commissioner for Children and Young People with custom reports on hospitalisation rates due to self-harm for WA young people aged 12 to 17 years.

In the six years from 2012 and 2017, there were a total of 3,841 hospitalisations due to intentional self-harm among young people aged 12 to 17 years in WA.

Rate of hospitalisations due to intentional self- harm among young people aged 12 to 17 years, age-adjusted rate, WA, 2012 to 2016

Age-adjusted rate

2012

31.0

2013

32.1

2014

23.7

2015

25.0

2016

27.8

Total (2012-2016)

27.9

Source: Custom report from the WA Department of Health, WA Hospital Morbidity Data Collection (HMDC) provided to the Commissioner for Children and Young People WA [unpublished]

Note: Age-adjusted rate per 100,000 population. Direct standardisation using all age groups of 2001 Australian Standard Population in order to compare rates between population groups and different years for the same population group.

The age-adjusted hospitalisation rates for WA young people aged 12 to 17 years were stable during the six years except between 2013 and 2014 when the rates dropped significantly from 32.1 per 100,000 in 2013 to 23.7 per 100,000 in 2014.

In each year, around 75 per cent of all hospitalisations were experienced by older teenagers aged between 15 and 17 years.

Proportion of hospitalisations due to intentional self-harm among young people aged 12 to 17 years by age, in per-cent, WA, 2012 to 2017

12 years

13 years

14 years

15 years

16 years

17 years

Total

2012

1.6

5.3

18.3

21.0

30.2

23.5

100.0

2013

1.4

7.5

16.0

24.5

25.6

25.0

100.0

2014

1.1

7.0

14.5

23.2

28.1

26.0

100.0

2015

2.5

6.6

15.7

18.9

29.5

26.8

100.0

2016

1.1

4.6

11.7

22.5

28.6

31.4

100.0

2017

1.8

6.0

11.4

21.9

27.8

31.1

100.0

Source: Custom report from the WA Department of Health, WA Hospital Morbidity Data Collection (HMDC) provided to the Commissioner for Children and Young People WA [unpublished]

WA female young people are five times more likely to be hospitalised for intentional self-harm than WA male young people (9.4 male young people per 100,000 in 2016 compared to 47.2 female young people per 100,000).

Hospitalisations due to intentional self-harm among young people aged 12 to 17 years by sex*, WA, number and age-adjusted rate, 2012 to 2017

Male

Female

Number

Age-adjusted
rate

Number

Age-adjusted
rate

2012

124

11.0

552

52.1

2013

121

10.5

590

55.1

2014

90

7.8

440

40.6

2015

90

7.8

470

43.1

2016

109

9.4

521

47.2

2017

121

n/a

613

n/a

Total

655

n/a

3,186

n/a

Source: Custom report from the WA Department of Health, WA Hospital Morbidity Data Collection (HMDC) provided to the Commissioner for Children and Young People WA [unpublished]

* The Hospital Morbidity Data Collection does not capture data on gender but biological sex (male/female).

n/a - rate is not available for 2017 at time of publication.

Among WA male young people, hospitalisation rates for intentional self-harm appeared stable over the five-year period, with a rate of 11.0 per 100,000 in 2012 falling slightly to 9.4 per 100,000 in 2016.

Among WA female young people, similarly, hospitalisation rates appeared relatively stable over the five-year period, with a rate of 52.1 per 100,000 in 2012, falling slightly to 47.2 per 100,000 in 2016. The exception was between the years 2013 and 2014, when hospitalisation rates fell significantly from 55.1 per 100,000 in 2013 to 40.6 per 100,000 in 2014.

These results are consistent with WA female young people accessing mental health services at a higher rate as reported in the Measure: Receiving services for mental health issues.

WA Aboriginal young people are also more likely to be hospitalised for intentional self-harm across all ages between 12 and 17 years.

Hospitalisations due to intentional self-harm among young people aged 12 to 17 years by age and Aboriginal status, number and age specific rate, WA, 2012 to 2016 combined

Non-Aboriginal

Aboriginal

Number

Age-specific rate

Number

Age-specific rate

12 years

38

26.7

10

n/a

13 years

167

117.3

25

244.9

14 years

434

302.7

43

427.1

15 years

636

438.9

51

514.6

16 years

797

543.1

83

851.4

17 years

760

508.5

63

656.7

Total

2,832

n/a

275

n/a

Source: Custom report from the WA Department of Health, WA Hospital Morbidity Data Collection (HMDC) provided to the Commissioner for Children and Young People WA [unpublished]

n/a - rates are not provided when the event numbers are less than 20 due to unreliable rates that are derived.

Hospitalisations due to intentional self-harm among young people aged 12 to 17 years by age and Aboriginal status, age‑specific rate, WA, 2012 to 2016 combined

Source: Custom report from the WA Department of Health, WA Hospital Morbidity Data System (HMDS) provided to the Commissioner for Children and Young People WA [unpublished]

No data is available on hospitalisation due to intentional self-harm by WA region.

Australian data suggests that people in regional and remote locations are more likely to exhibit self-harm behaviour. In 2014-15, the lowest age-standardised rate of hospitalisations due to intentional self-harm (adults and children) was in major cities across Australia (108.3 per 100,000 population) and the highest in very remote areas (168.7 per 100,000).12

Young people in the youth justice system

Young people in the youth justice system are more likely to have mental health issues.13 The Banksia Hill Detention Centre is the only facility in WA for the detention of children and young people 10 to 17 years of age who have been remanded or sentenced to custody. During 2017-18, approximately 148 children and young people aged between 10 and 17 years were held in the Banksia Hill Detention Centre in WA on an average day.14

In their 2017 inspection of the Banksia Hill facility, the Office of the Inspector of Custodial Services reported that there had been a significant increase in self-harm and attempted suicide incidents in 2016 and 2017.

Incidents of self-harm and attempted suicide at Banksia Hill, number of incidents, WA, 2012 to 2017

2012

2013

2014

2015

2016

2017

Self-harm

74

71

37

77

191

184

Attempted suicide

1

1

1

0

5

5

Source: Office of the Inspector of Custodial Services 2018, 2017 Inspection of Banksia Hill Detention Centre

There is no information on the number of children and young people involved in the incidents.

The Inspector of Custodial Services reported that the frequency of critical incidents in 2016 meant that the young people spent more time locked in their cells, which had the effect of increasing the risk of self-harm and making it more difficult for psychologists to access the young people to provide counselling.15

There is no further breakdown by age, Aboriginal status or gender of the children and young people self-harming or attempting suicide in the centre.

Lesbian, gay, bisexual, transgender and intersex

Lesbian, gay, bisexual, transgender and intersex (LGBTI)16 young people are also at an increased risk of a range of mental health problems, including depression, anxiety disorders, self-harm and suicide.17

The issues that affect LGBTI people largely stem from social and cultural beliefs and assumptions about gender and sexuality. As a result of these beliefs and social norms they have a much higher likelihood of experiencing abuse, violence and systemic discrimination at an individual, social, political and legal level than non-LGBTI people.18

Administrative data on the prevalence of self-harm behaviour for children and young people who identify as LGBTI are not available as unlike other demographic characteristics this is not identified in most data collections.19

Survey data has found that almost one-quarter of same-sex attracted Australians experienced a major depressive episode in 2005 and have up to 14 times higher rates of suicide attempts than their heterosexual peers.20 Furthermore, four out of five trans young people (aged 25 years or under) have engaged in self-harm and almost one in two trans young people have attempted suicide over their lifetime (48.1%).21

Australian longitudinal research has also shown that adolescents (aged 14 and 15 years old) were at a greater risk of engaging in self‑harm behaviour or a suicide attempt if they reported being attracted to adolescents of the same gender, or both genders, or not being attracted to anyone.22

There is no data on the prevalence of self-harm behaviour for WA LGBTI children or young people.

Endnotes

  1. Australian Institute of Health and Welfare (AIHW) 2018, Trends in hospitalised injury, Australia 1999–00 to 2014–15, Injury research and statistics series No 110, Cat No INJCAT 190, AIHW, p. 96.
  2. Daraganova G 2016, Self-harm and suicidal behaviour of young people aged 14-15 years old in The Longitudinal Study of Australian Children: Annual statistical report 2016, Australian Institute of Family Studies, p. 119.
  3. Lifeline 2018, Self-harm [website], viewed 30 January 2019.
  4. Daraganova G 2016, Self-harm and suicidal behaviour of young people aged 14-15 years old in The Longitudinal Study of Australian Children: Annual statistical report 2016, Australian Institute of Family Studies, p. 120.
  5. Gillies D et al 2018, Prevalence and Characteristics of Self-Harm in Adolescents: Meta-Analyses of Community-Based Studies 1990–2015, Journal of the American Academy of Child & Adolescent Psychiatry, Vol 57, No 10.
  6. Daraganova G 2016, Self-harm and suicidal behaviour of young people aged 14-15 years old in The Longitudinal Study of Australian Children: Annual statistical report 2016, Australian Institute of Family Studies, p. 119.
  7. headspace 2018, Mythbuster: Sorting fact from fiction on self-harm, headspace, National Youth Mental Health Foundation.
  8. Australian Institute of Health and Welfare (AIHW) 2018, Trends in hospitalised injury, Australia 1999–00 to 2014–15, Data Table Chapter 11 – Intentional Self-Harm, Injury research and statistics series No 110, Cat No INJCAT 190, AIHW.
  9. Ibid.
  10. Lawrence D et al 2015, The Mental Health of Children and Adolescents: Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing, Department of Health, p. 103.
  11. Ibid, p. 105.
  12. Australian Institute of Health and Welfare (AIHW) 2018, Trends in hospitalised injury, Australia 1999–00 to 2014–15, Injury research and statistics series No 110, Cat No INJCAT 190, AIHW, p. 98.
  13. Justice Health & Forensic Mental Health Network and Juvenile Justice NSW 2015, 2015 Young People in Custody Health Survey: Full Report, NSW Government, p. 65.
  14. WA Department of Justice 2018, Annual Report: 2017-18, WA Government, p. 15.
  15. Office of the Inspector of Custodial Services 2018, 2017 Inspection of Banksia Hill Detention Centre, WA Government, p. 41.
  16. The Commissioner for Children and Young People understands there are a range of terms and definitions that people use to define their gender or sexuality. The Commissioner’s office will use the broad term LGBTI to inclusively refer to all people who are lesbian, gay, bisexual, trans and intersex, as well as to represent other members of the community that use different terms to describe their diverse sexuality and/or gender.
  17. Leonard W et al 2012, Private Lives 2: The second national survey of the health and wellbeing of gay,lesbian, bisexual and transgender (GLBT) Australians, Monograph Series Number 86, The Australian Research Centre in Sex, Health & Society, La Trobe University.
  18. Rosenstreich G 2013, LGBTI People Mental Health and Suicide, Revised 2nd Edition, National LGBTI Health Alliance, p. 4.
  19. WA Ombudsman 2014, Investigation into ways that State government departments and authorities can prevent or reduce suicide by young people, WA Government, p. 35.
  20. Rosenstreich G 2013, LGBTI People Mental Health and Suicide, Revised 2nd Edition, National LGBTI Health Alliance, p. 3.
  21. Strauss P 2017, Trans Pathways: the mental health experiences and care pathways of trans young people, Telethon Kids Institute, p. 33.
  22. Daraganova G 2016, Self-harm and suicidal behaviour of young people aged 14-15 years old in The Longitudinal Study of Australian Children: Annual statistical report 2016, Australian Institute of Family Studies, p. 132-133.
Measure: Suicide rate

The content for this measure considers rates of suicide and self-harm in children which can be distressing. If you or anyone you know needs urgent help please contact Lifeline on 13 11 14 or the Kids Helpline on 1800 55 1800. Support is also available through headspace and beyond blue.

In 2017, suicide (or death by intentional self-harm) was the leading cause of death for WA young people aged between 13 and 17 years.1

It is important to note that while this measure is included under the Mental Health indicator, not all people who die by suicide have a mental illness. International research highlights that mental illness is present in up to 90 per cent of people who die by suicide in higher socio-economic countries.2 However, other risk factors for children and young people include bullying, substance abuse and lesbian, gay, bisexual, trans and intersex (LGBTI)3 status.4 It should also be noted that not having a mental illness, is not the same as having good mental health.

Caution should be used when interpreting data for suicide, particularly in relation to children and young people, due to the low numbers involved and difficulty in determining intent in the cause of death for suicide.

The WA Ombudsman annually reports on the number of deaths of WA children and young people due to suicide. The WA Ombudsman reports that 112 WA young people aged 13 to 17 years apparently took their own lives between 30 June 2009 and 30 June 2018.5

Suicides of WA children and young people under 18 years of age by age group, number, WA, 2009-10 to 2017-18

6 to 12 years

13 to 17 years

Total

2009-10

0

9

9

2010-11

0

11

11

2011-12

0

11

11

2012-13

1

17

18

2013-14

1

9

10

2014-15

1

12

13

2015-16

1

13

14

2016-17

0

19

19

2017-18

1

11

12

Total

5

112

117

Source: WA Ombudsman 2018, Annual Report 2017-18

Young people aged 15 to 17 years are more likely to die by suicide than young people aged under 15 years of age.

Suicide by young people by age, number, WA, 2009-10 to 2017-18

2009-10 to 2017-18

< 13 years

5

13 years

6

14 years

11

15 years

26

16 years

29

17 years

40

Total

117

Source: WA Ombudsman 2018, Annual Report 2017-18

The deaths of children and young people in WA through suicide have been subject to a number of inquiries, for further information refer to:

WA Ombudsman 2014, Investigation into ways that State government departments and authorities can prevent or reduce suicide by young people, WA Government.

Education and Health Standing Committee 2016, Learnings from the message stick: The report of the Inquiry into Aboriginal youth suicide in remote areas, WA Legislative Assembly.

WA State Coroner 2019, Inquest into the deaths of: Thirteen children and young persons in the Kimberley region, Western Australia, WA Government.

Over the years 2013 to 2017, WA reported the second-highest jurisdictional age-specific rate of deaths due to suicide for children and young people, with 0.9 deaths per 100,000 children aged five to 14 years, and 11.9 deaths per 100,000 young people aged 15 to 17 years.

Children and young people aged 5 to 17 years who die by suicide, age-specific rate, state and territory 2013 to 2017

5 to 14 years

15 to 17 years

New South Wales

0.5

7.3

Victoria

0.3

6.2

Queensland

0.9

9.1

South Australia

0.5

6.2

Western Australia

0.9

11.9

Tasmania

n/p

n/p

Northern Territory

4.1

50.8

Australian Capital Territory

n/p

n/p

Australia

0.7

8.4

n/p - Not published

Note: Age-specific rate is the number of deaths for an age group divided by the population for the age group, expressed as per 100,000 population.

This will be at least partly attributable to the higher proportion of people living in remote and very remote locations in WA than other jurisdictions, except the Northern Territory.6 As outlined under the measure, Receiving services for mental health issues, data suggests that children and young people in remote and regional locations have a much higher likelihood of experiencing mental health issues.7 This is for a variety of reasons including socio-economic disadvantage, isolation, greater misuse of drugs and alcohol and concerns about finding work in the future.8,9

Data from the Australian Bureau of Statistics shows that children and young people in regional and remote WA have a higher age-specific rate of suicide (6.4 per 100,000) than children and young people in metropolitan Perth (2.5 per 100,000).

Deaths due to intentional self-harm in children and young people aged 5 to 17 years by age and region, number and age-specific rate, WA, 2013 to 2017

Male

Female

Persons

Number

Age-specific rate

Number

Age-specific rate

Number

Age-specific rate

Greater Perth

26

3.2

13

1.7

39

2.5

Rest of WA

18

7.6

12

5.2

30

6.4

Source: Australian Bureau of Statistics 2018, 3303.0 Causes of Death, 2017, Intentional Self-Harm, Table 11.13 Intentional self-harm, Number of deaths in children aged 5-17 years by age and capital city areas/remainder of state, 2013-2017

Notes: 

1. Region is represented by Statistical Area Level 4s (SA4s) grouped in accordance with the classification from ASGS: Volume 1 - Main structure and greater capital city statistical areas, July 2016 (cat. no. 1270.0.55.001).

2. Age-specific death rates reflect deaths per 100,000 of the estimated resident population (ERP) for a specific age group, as at 30 June.

In their research with young people in regional and remote Australia, Reach Out and Mission Australia report that there is a considerable unmet need for professional help amongst young people in regional and remote Australia, with just over half (51.7 per cent) of all young people who indicated they had a problem for which they needed professional help, not seeking this type of help.10 Reported barriers to seeking help included fear that they may have to do or say something they didn’t want to do or say (around 50%), a desire for self-reliance (around 47%) and practical considerations such as the affordability of professional services (48.1%).11

Data shows that female young people are more likely to self-harm and attempt suicide than male young people however male young people are more likely to die through suicide.12

Children and young people aged 6 to 17 years who die by suicide by gender and age group, age-specific rate, Australia, 2013 to 2017

Male

Female

Total

5 to 14 years

0.7

0.6

0.7

15 to 17 years

10.4

6.2

8.4

5 to 17 years (total)

2.9

1.9

2.4

Source: Australian Bureau of Statistics, 3303.0 Causes of Death, 2017

Note: Age-specific death rates reflect deaths per 100,000 of the estimated resident population (ERP) for a specific age group, as at 30 June.

In 2017, the age-specific death rate due to suicide for Australian male young people aged 15 to 17 years was 10.4 deaths per 100,000 people, while for female young people it was 6.2 deaths per 100,000 people.13

Children and young people aged 6 to 17 years who die by suicide by gender, number, WA, 2009-10 to 2017-18

Male

Female

Total

2009-10

7

2

9

2010-11

7

4

11

2011-12

4

7

11

2012-13

10

8

18

2013-14

6

4

10

2014-15

9

4

13

2015-16

8

6

14

2016-17

13

6

19

2017-18

8

4

12

Total

72

45

117

Source: WA Ombudsman 2018, Annual Report 2017-18

Due to the small numbers, age-specific rates are not available by gender for WA, however in every year in the past nine years, except for 2015-16, more male children and young people died through suicide than female children and young people.

Research suggests a number of reasons that male young people appear less likely to self-harm, but more likely to die through suicide. These include that the methods male young people use are more lethal (for examples firearms, rather than poisoning) and there is some evidence to suggest that gender-specific beliefs and attitudes, may influence male and female young people.14

Researchers using data from the Longitudinal Study of Australian Children (LSAC) found that of those who attempted suicide, only 36 per cent of male young people also engaged in self-harm, while 80 per cent of female young people who attempted suicide engaged in self-harm.15 Other research has also found that male young people are more likely to attempt suicide without planning; that is male young people exhibit a higher level of impulsivity.16

This research does not consider Aboriginal children and young people and the historical and social context that leads to a higher rate of suicide for Aboriginal young people.

Research and data regarding the different suicide pathways for young people is critical to inform preventative policy and programs.

Although caution should be employed as the numbers are small, the data from the ABS by age and region also suggests that while male children and young people in Perth are much more likely to die by suicide than female children and young people; in regional and remote WA the gap between the male and female age-specific suicide rate narrows considerably.

Over 2013 to 2017, the age-specific death rate due to intentional self-harm for WA Aboriginal children and young people aged five to 17 years (20.2 per 100,000) was almost 10 times higher than non-Aboriginal WA children and young people (2.1 per 100,000).17

Deaths due to intentional self-harm for children and young people aged 5 to 17 years by Aboriginal status, age-specific rates, NSW, QLD, WA and NT, 2013-2017

Aboriginal*

Non-Aboriginal

Total

New South Wales

5.2

1.8

2.0

Northern Territory

24.7

5.1

13.9

Queensland

7.1

2.4

2.7

Western Australia

20.2

2.1

3.4

Total

10.1

2.0

2.6

Source: Australian Bureau of Statistics 2018, 3303.0 Causes of Death, 2017, Intentional Self-Harm, Table 11.12 Intentional self-harm, Number of deaths in children aged 5-17 years by Aboriginal and Torres Strait Islander status, NSW, Qld, SA, WA and NT, 2013-2017

Notes:

1. Data is only available for NSW, QLD, NT and WA.

2. Age-specific death rates reflect deaths per 100,000 of the estimated resident population (ERP) for a specific age group, as at 30 June.

* Although most deaths of Aboriginal people are registered, it is likely that some are not accurately identified as Aboriginal. Therefore, these data are likely to underestimate the Aboriginal mortality rate.

WA also has a significantly higher age-specific death rate due to intentional self-harm for Aboriginal children and young people aged five to 17 years (20.2 per 100,000) in comparison to the available data for New South Wales (5.2 per 100,000) and Queensland (7.1 per 100,000). In particular, the Kimberley region has one of the highest suicide rates in Australia and internationally.18

Similar to trends in the general population, in 2016 the WA Primary Health Alliance reported that the suicide rate for 15 to 17 year old Aboriginal male young people (37.8 per 100,000 persons) was more than double the rate for Aboriginal female young people (16.1 per 100,000).19

The reasons for such high suicide rates of Aboriginal children and young people in WA are related to the interaction of personal, historical and social factors including intergenerational trauma due to colonisation, poverty and social exclusion, and associated drug and alcohol issues.20,21

Young people in the youth justice system

Young people in the youth justice system are more likely to have mental health issues.22 The Banksia Hill Detention Centre is the only facility in WA for the detention of children and young people 10 to 17 years of age who have been remanded or sentenced to custody. During 2017-18, approximately 148 children and young people aged between 10 and 17 years were held in the Banksia Hill Detention Centre in WA on an average day.23

In their 2017 inspection of the Banksia Hill facility, the Office of the Inspector of Custodial Services reported that there had been a significant increase in self-harm and attempted suicide incidents in 2016 and 2017.

Incidents of self-harm and attempted suicide at Banksia Hill, number of incidents, WA, 2012 to 2017

2012

2013

2014

2015

2016

2017

Self-harm

74

71

37

77

191

184

Attempted suicide

1

1

1

0

5

5

Source: Office of the Inspector of Custodial Services 2018, 2017 Inspection of Banksia Hill Detention Centre

There is no information on the number of children and young people involved in the incidents.

The Inspector of Custodial Services reported that the frequency of critical incidents in 2016 meant that the young people spent more time locked in their cells, which had the effect of increasing the risk of self-harm and making it more difficult for psychologists to access the young people to provide counselling.24

There is no further breakdown by age, Aboriginal status or gender of the children and young people self-harming or attempting suicide in the centre.

Lesbian, gay, bisexual, trans and intersex

Children and young people who identify as lesbian, gay, bisexual, trans and intersex (LGBTI) also have very high rates of mental health issues including self-harm and suicide.25 The issues that affect LGBTI people largely stem from social and cultural beliefs and assumptions about gender and sexuality. As a result of these beliefs and social norms they have a much higher likelihood of experiencing abuse, violence and systemic discrimination at an individual, social, political and legal level than non-LGBTI people.26

Administrative data on suicide rates for WA children and young people who identify as LGBTI are not available as unlike other demographic characteristics this is not identified in most data collections.27

Survey research has found that almost one-quarter of same-sex attracted Australians experienced a major depressive episode in 2005 and young same-sex attracted Australians have up to six times higher rates of suicide attempts than their heterosexual peers.28 Furthermore, four out of five trans young people (aged 25 years or under) have engaged in self-harm and almost one in two trans young people have attempted suicide over their lifetime (48.1%).29

No data is available on the prevalence of death by suicide for WA children and young people who identify as LGBTI.

Culturally and linguistically diverse children

Research suggests that culturally and linguistically diverse (CALD) people may be at a higher risk of suicide compared to the general population in their resident country. Risk factors and triggers for suicidal behaviour include: language barriers, separation from family, and loss of status and social networks.30

A recent research project in WA considered how to identify health risk behaviours among adolescent refugees resettling in WA. They interviewed 122 young people and found that almost half (49%) had a deceased/missing family member, a third (37%) had lived in refugee camps and 20 per cent had experienced closed detention. A third of study participants reported witnessing trauma and 9 per cent experienced direct trauma.31

There is limited research or data on suicide among children and young people of CALD backgrounds in WA.32

No data is available on the prevalence of death by suicide for children and young people in the CALD community in WA.

Endnotes

  1. WA Ombudsman 2018, Annual Report 2017-18, WA Government, p. 79.
  2. World Health Organisation (WHO) 2014, Preventing suicide: A global imperative, WHO, p. 40.
  3. The Commissioner for Children and Young People understands there are a range of terms and definitions that people use to define their gender or sexuality. The Commissioner’s office will use the broad term LGBTI to inclusively refer to all people who are lesbian, gay, bisexual, trans and intersex, as well as to represent other members of the community that use different terms to describe their diverse sexuality and/or gender.
  4. Asarnow J et al 2018, Child and Adolescent Suicide and Self Harm: Treatment and Prevention, Psychiatric Times, Vol 35, No 12.
  5. WA Ombudsman 2018, Annual Report 2017-18, WA Government, p. 80.
  6. Australian Bureau of Statistics (ABS) 2008, 4102.0 - Australian Social Trends, 2008, ABS.
  7. Lawrence D et al 2015, The Mental Health of Children and Adolescents: Report on the second Australian Child and Adolescent Survey of Mental Health and Wellbeing, Department of Health, p. 28
  8. Enticott J et al 2016, Mental disorders and distress: Associations with demographics, remoteness and socioeconomic deprivation of area of residence across Australia, Australian & New Zealand Journal of Psychiatry, Vol 50 No 12.
  9. Ivancic L et al 2018, Lifting the weight: Understanding young people’s mental health and service needs in regional and remote Australia, ReachOut Australia and Mission Australia.
  10. Ibid, p. 7.
  11. Ibid, p. 40.
  12. Gender Paradox in Suicide, Suicide and Life Threatening Behaviour, Vol 28 No 1.
  13. Australian Bureau of Statistics (ABS) 2018, 3303.0 - Causes of Death, Australia, 2017, Intentional Self-Harm, key characteristics, ABS.
  14. Freeman A et al 2017, A cross-national study on gender differences in suicide intent, BMC Psychiatry, Vol 17.
  15. Daraganova G 2016, Self-harm and suicidal behaviour of young people aged 14-15 years old in The Longitudinal Study of Australian Children: Annual statistical report 2016, Australian Institute of Family Studies, p. 125.
  16. Simon TR et al 2001, Characteristics of Impulsive Suicide Attempts and Attempters, Suicide and Life Threatening Behaviour, Vol 32.
  17. Australian Bureau of Statistics (ABS) 2018, 3303.0 - Causes of Death, Australia, 2017, Intentional Self-Harm in Aboriginal and Torres Strait Islander people, ABS.
  18. McHugh C 2016, Increasing Indigenous self-harm and suicide in the Kimberley: an audit of the 2005–2014 data, Medical Journal of Australia, Vol 205, No 1.
  19. WA Primary Health Alliance (WAPHA) 2016, WA Primary Health Alliance submission to the Education and Health Standing Committee Inquiry into Aboriginal Youth Suicides, WAPHA, p. 2.
  20. Dudgeon P and Holland C 2017, The contexts and causes of suicide among Aboriginal and Torres Strait Islander people, Aboriginal and Torres Strait Islander Suicide Prevention Evaluation Project.
  21. WA State Coroner 2019, Inquest into the deaths of: Thirteen children and young persons in the Kimberley region, Western Australia, WA Government, p. 8.
  22. Justice Health & Forensic Mental Health Network and Juvenile Justice NSW 2015, 2015 Young People in Custody Health Survey: Full Report, NSW Government, p. 65.
  23. WA Department of Justice 2018, Annual Report: 2017-18, WA Government, p. 15.
  24. Office of the Inspector of Custodial Services 2018, 2017 Inspection of Banksia Hill Detention Centre, WA Government, p. 41.
  25. The Commissioner for Children and Young People understands there are a range of terms and definitions that people use to define their gender or sexuality. The Commissioner’s office will use the broad term LGBTI to inclusively refer to all people who are lesbian, gay, bisexual, trans and intersex, as well as to represent other members of the community that use different terms to describe their diverse sexuality and/or gender.
  26. Rosenstreich G 2013, LGBTI People Mental Health and Suicide, Revised 2nd Edition, National LGBTI Health Alliance, p. 4.
  27. WA Ombudsman 2014, Investigation into ways that State government departments and authorities can prevent or reduce suicide by young people, WA Government, p. 35.
  28. Rosenstreich G 2013, LGBTI People Mental Health and Suicide, Revised 2nd Edition, National LGBTI Health Alliance, p. 3.
  29. Strauss P 2017, Trans Pathways: the mental health experiences and care pathways of trans young people, Telethon Kids Institute, p. 33.
  30. Forte A et al 2018, Suicide Risk among Immigrants and Ethnic Minorities: A Literature Overview, International Journal of Environmental Research and Public Health, Vol 15, No 7.
  31. Hirani K et al 2017, Identification of health risk behaviours among adolescent refugees resettling in Western Australia, Archives of disease in childhood, Vol 103.
  32. Colucci E et al 2017, A suicide research agenda for people from immigrant and refugee backgrounds, Death Studies, Vol 41, No 8.
Young people in care

At 30 June 2018 there were approximately 2,240 young people aged between ten and 17 years in care in WA, more than half (51.9%) of whom were Aboriginal.1

A key factor in child and adult mental illness is ‘excessive or prolonged activation of stress response systems in the body and brain’ or toxic stress.2 Toxic stress can occur when children are repeatedly exposed to abuse, neglect, food scarcity, household dysfunction, violence and/or caregivers with substance abuse or mental health issues.3 Children who have experienced toxic stress in early childhood are more likely to develop significant mental and physical health issues in later life.4

Children and young people in care have generally experienced significant adverse events on an ongoing basis. These may include neglect, food scarcity and physical, sexual or emotional abuse. These factors are primary contributors to children developing mental health issues.

Unsurprisingly, research shows that children in care are more likely than the general population to have mental health issues.5,6,7

The WA Department of Communities casework practice manual requires that all children who come into care aged four years and older should have a Strengths and Difficulties Questionnaire (SDQ)completed once they have been in care for six months (or earlier if they are settled in the care arrangement), and then on an annual basis.9

In 2016, the WA Department of Child Protection (now Department of Communities) published the Outcomes Framework for Children in Out-of-Home Care 2015-16 Baseline Indicator Report. The outcomes framework identified the following indicator related to reviewing the mental health of children in care: the ‘proportion of children aged four and older who have had an annual health check of their psychosocial and mental health needs’.10

In this report they noted that there were limitations in data accuracy which prevented reporting on this indicator in 2015-16, however data would be reported in 2016-17.11 No data has been reported on this indicator as at publication date.

The Children in out-of-home care Report Card 2016 prepared by Anglicare Victoria found that a much larger proportion of children and young people in care in Victoria (42.1%) compared to the general population (10.2%) were at risk of developing clinically significant behavioural problems, as measured by the Strengths and Difficulties Questionnaire. They noted that the difference is not unexpected given the adversity that characterises the lives of children and young people in the child protection system.12

The United Nations Convention on the Rights of the Child, ratified by Australia in 1990, recognises the right of children to ‘the enjoyment of the highest attainable standard of health’ and that children in care have a right to a periodic review of their health, treatment and placement.13

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) note that children and young people in care ‘warrant special attention and priority access to comprehensive health and developmental assessments and multi-disciplinary mental health care that can address their complex health, psychosocial and developmental needs’.14

There is no data on the prevalence of mental health issues including self-harm or death by suicide for WA young people in care aged between 12 and 17 years.

Endnotes

  1. Department of Communities 2019, 2017-18 Annual Report, Child Protection Activity Performance Report 2017-2018, WA Government.
  2. Center on the Developing Child 2018, Toxic Stress, Harvard University [website].
  3. Franke H 2014, Toxic Stress: Effects, Prevention and Treatment, Children, Vol 1.
  4. Ibid.
  5. Sawyer M et al 2007, The mental health and wellbeing of children and adolescents in home-based foster care, The Medical Journal of Australia, Vol 186, No 4.
  6. NSW Department of Community Services 2007, Mental Health of Children in Out-Of-Home Care in NSW, Australia, Centre for Parenting and Research, NSW Government.
  7. The Royal Australian and New Zealand College of Psychiatrists 2015, Position Statement 59: The mental health care needs of children in out-of-home care, The Royal Australian and New Zealand College of Psychiatrists.
  8. The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioural screening questionnaire about 3-16 year olds. It considers emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behaviour. Refer to https://sdqinfo.org/a0.html for more information.
  9. Department of Child Protection and Family Support (Department of Communities), Casework Practice Manual: Healthcare Planning, WA Government.
  10. Department for Child Protection and Family Support (Department of Communities) 2016, Outcomes Framework for Children in Out-of-Home Care 2015-16 Baseline Indicator Report, WA Government, p. 10.
  11. Ibid, p. 10.
  12. Kandasamy N et al 2016, Children in Care Report Card, Anglicare Victoria.
  13. Australian Human Rights Commission, Convention on the Rights of the Child, [website].
  14. Royal Australian and New Zealand College of Psychiatrists 2015, Position Statement 59: The mental health care needs of children in out-of-home care, Royal Australian and New Zealand College of Psychiatrists.
Young people with disability

The Australian Bureau of Statistics Disability, Ageing and Carers data collection reports that approximately 23,700 WA children and young people (7.5%) aged five to 14 years have a reported disability.1,2

There is no data on the prevalence of mental health issues for WA young people with disability aged 12 to 17 years.

Children with intellectual and physical disabilities are more likely to experience mental health issues than the general population.3 A study in the United Kingdom found that children with an intellectual disability were four times more likely to have a psychiatric disorder than a child without an intellectual disability.4

In an evaluation of the KidsMatter mental health initiative in South Australia (now renamed Be You), the evaluation team considered the effects of the KidsMatter program on South Australian primary school students with disability. As part of this research they concluded that students without a disability had one in eight chance of having mental health difficulties, students with one identified disability had a one in three chance and students with multiple disabilities had a one in two chance.5

Living with disability can contribute to mental health difficulties due to a range of adverse individual and environmental issues associated with disability. These can include experiences of discrimination, bullying and exclusion. Some disabilities can also make it difficult for young people to communicate, develop supportive social relationships and self-regulate their behaviour.6 In some instances mental illness can lead to psychosocial disability where a person is unable to participate fully in life due to mental ill-health.7

The Commissioner’s 2011 inquiry into the mental health and wellbeing of children and young people identified gaps in services for children with disability and mental health issues. The Commissioner’s Report of the Inquiry into the mental health and wellbeing of children and young people in Western Australia recommended that the Disability Services Commission work with the Mental Health Commission to identify the services required to address the unique needs and risk factors for children with disabilities in a coordinated and seamless manner (Recommendation 25).8

Since that time there has been some changes to services that can cater to young people with complex needs including disability, for example the Young People with Exceptionally Complex Needs (YPECN) program.9 Additionally, the Mental Health Commissioner sponsored ‘A Core Capability Framework: For working with people with intellectual disability and co-occurring mental health issues’ and a National Roundtable on Intellectual Disability Mental Health was held in March 2018.

The National Disability Insurance Scheme (NDIS) is currently being rolled out across WA and will cover some individuals with mental health issues. A person has access to the NDIS where a mental health condition results in a loss of, or damage to, physical or mental function.10 The roll out of the NDIS should be monitored closely, to ensure that children and young people in WA are able to access the services and supports that they require under the scheme.  

For more information on mental health and children and young people with a disability refer to the Commissioner’s paper: The mental health and wellbeing of children and young people: Children and young people with disability.

Endnotes

  1. ABS uses the following definition of disability: ‘In the context of health experience, the International Classification of Functioning, Disability and Health (ICFDH) defines disability as an umbrella term for impairments, activity limitations and participation restrictions… In this survey, a person has a disability if they report they have a limitation, restriction or impairment, which has lasted, or is likely to last, for at least six months and restricts everyday activities.’ Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia, 2015, Glossary.
  2. Estimate is to be used with caution as it has a relative standard error of between 25 and 50 per cent. Australian Bureau of Statistics 2016, Disability, Ageing and Carers, Australia, 2015: Western Australia, Table 1.1 Persons with disability, by age and sex, 2012 and 2015 estimate, and Table 1.3 Persons with disability, by age and sex, 2012 and 2015, proportion of persons.
  3. Dix K et al 2013, KidsMatter and young children with disability: Evaluation Report, Flinders Research Centre for Student Wellbeing & Prevention of Violence, Shannon Research Press, p. xi.
  4. Emerson E and Hatton C 2007, Mental health of children and adolescents with intellectual disabilities in Britain, British Journal of Psychiatry, Vol 191.
  5. Dix K et al 2010, KidsMatter for students with a disability: Evaluation Report, Ministerial Advisory Committee: Students with Disabilities, The Centre for Analysis of Educational Futures, Flinders University.
  6. Dix K et al 2013, KidsMatter and young children with disability: Evaluation Report, Flinders Research Centre for Student Wellbeing & Prevention of Violence, Shannon Research Press, p. 15.
  7. Mental Health Australia 2014, Getting the NDIS right for people with psychosocial disability, Mental Health Council of Australia.
  8. Commissioner for Children and Young People WA 2011, Report of the Inquiry into the mental health and wellbeing of children and young people in Western Australia, Commissioner for Children and Young People WA.
  9. Commissioner for Children and Young People WA 2015, Our Children Can’t Wait – Review of the implementation of recommendations of the 2011 Report of the Inquiry into the mental health and wellbeing of children and young people in WA, Commissioner for Children and Young People WA, p. 54.
  10. National Disability Insurance Scheme, Mental health and the NDIS – Access Snapshot 2 Impairment and Mental Health in the NDIS, Australian Government [website].
Policy implications

Good mental health is essential to enable young people to participate fully in education, develop fulfilling relationships, manage change successfully and cope with difficulties.1

Poor mental health in childhood or adolescence can set a negative trajectory for ongoing mental health issues in adulthood, and is associated with a broad range of poor adult health outcomes.2 Estimates suggest that between one-quarter to one-half of adult mental illness may be preventable with appropriate interventions in childhood and adolescence.3

Risk factors for mental health issues in young people include poor health, family violence and disharmony, parental substance misuse, bullying, poverty and physical, sexual and emotional abuse.4 Protective factors include supportive and caring parents, good physical health, a positive school environment, a strong cultural identity and access to high quality and culturally appropriate support services.5

Research also shows that having an optimistic or positive outlook on life is a protective factor for mental health issues, in particular anxiety and depression.6 Higher levels of optimism have been linked to better subjective wellbeing, more persistence, resilience and coping mechanisms, and also better physical health.7

In 2011 more than more than 700 children and young people aged between seven and 23 years shared their views with the Commissioner about what mental health means to them.8 These children and young people’s views about maintaining positive mental health were around feeling healthy, positive, loved, acknowledged and informed. They also specifically raised concerns around family conflict, bullying, the negative impacts of drug and alcohol use, stress and peer pressure.9

Young people aged 12 to 17 years are also experiencing the various physical, cognitive and emotional changes that the transition to adulthood brings and can start to face specific challenges associated with that transition. In particular issues concerning peer relationships including body image, sexual identity and self-esteem issues.

In 2011, the Commissioner for Children and Young People WA published the Report of the Inquiry into the mental health and wellbeing of children and young people in Western Australia which found that the mental health needs of children and young people had not been prioritised and there was an urgent need for reform. In 2015, the Commissioner published a follow-up Our Children Can’t Wait report which found that progress has been made since 2011, however significant gaps remained, with WA children and young people’s mental health still not comprehensively supported.

It is recognised that both the Commonwealth and State Governments have undertaken significant review, reform and planning in relation to mental health, and that some progress has occurred on many of the recommendations. However, there is still no strategy which comprehensively addresses the mental health needs for children and young people in WA. Furthermore, while there is a suicide prevention strategy for the state, there is no specific strategy to address the issues affecting children and young people.

At the same time, there remain insufficient services and supports for children and young people related to mental health promotion, prevention, early intervention and specialist mental health services and programs.10,11

There is also limited data available to assess whether outcomes for young people aged 12 to 17 years have improved as a result of any changes in service provision and investment.

Universal programs for all children that strengthen social and emotional skills and increase optimism are critical. Programs provided in schools can have a significant influence on mental health outcomes, improving children and young people’s self-esteem, social competence and decreasing emotional and behavioural problems.12,13 For example, the Aussie Optimism Program is an evidence-based intervention program for upper primary school children (Years 4 to 8) that provides teachers, practitioners and parents with practical strategies for developing children’s social competence, self-management, and positive thinking.14 It is however, always important to involve parents and families in any school-based initiatives.15 

Research and data shows that some young people are more vulnerable to experiencing mental health issues. These include young people living in remote and regional locations, Aboriginal young people, LGBTI young people, young people in care and young people with a disability. Early intervention programs and services across the state are required to prevent at risk children and young people from reaching the stage of requiring treatment for more severe mental health illnesses.

Young people in regional and remote areas have a much higher risk of experiencing mental health issues including self-harm behaviour and suicide, yet they have lower access to Medicare‑funded services and significantly less access to specialised psychological services.16 Better access to quality services in regional and remote WA is essential.

Aboriginal young people are more likely than non-Aboriginal young people to have significant mental health issues including self-harm behaviours and suicide. Intergenerational disadvantage, entrenched poverty, crowded housing and high levels of preventable health issues, which are present in many Aboriginal communities, cause additional stressors or risk factors for Aboriginal young people. Additionally, ‘trauma, premature death and grief are experienced at disturbingly high rates in Aboriginal communities.’17

Aboriginal youth suicide has been the subject of multiple inquiries and numerous recommendations have been made – many of which have not been actioned.18 The 2019 WA State Coroner’s report, Inquest into the deaths of: Thirteen children and young persons in the Kimberley region, Western Australia, highlighted that most of the children and young people had previously voiced suicidal ideation or intent, but with the exception of one child, none had been directed to a primary health service or mental health service.19

In the 2019 Coroner’s report, the WA State Coroner made 42 recommendations including screening for Fetal Alcohol Spectrum Disorder (FASD), initiatives to improve school attendance, community-based programs to manage alcohol consumption, training in suicide intervention and prevention and construction of a mental health facility in the East Kimberley.20

Despite the previous inquiries, findings and recommendations in this space, there is still no single strategy which comprehensively addresses Aboriginal child and youth suicide in WA, or which takes a holistic and integrated approach to prevention and intervention.

Services and programs for all Aboriginal children and young people and their families must be culturally appropriate, trauma-informed, supported by the local community and tailored to recognise the importance of culture and healing to address the impact of intergenerational trauma.21

It is also critical that programs and services are flexible, understand and respect the diversity of Aboriginal children and young people and their communities, their language, their culture and their histories, and be able to respond to their unique circumstances, needs, strengths and capacities. This requires approaches that are local, cooperative and, ultimately, community-led and controlled.

For further information on the mental health of Aboriginal children and young people refer to the Commissioner’s Policy Brief: The mental health and wellbeing of children and young people: Aboriginal and Torres Strait Islander children and young people.

Lesbian, gay, bisexual, trans and intersex (LGBTI) children and young people have an unacceptably high risk of mental health problems, including depression, anxiety, self-harm and suicidal thought.22 Young people and may experience a range of challenges relating to their sexual orientation, gender identity or intersex status. These include issues relating to making sense of their identity, “coming out” to family and friends and being bullied or excluded at school.

There is a clear link between young people’s experiences of homophobic or transphobic discrimination and abuse with poor mental health outcomes, self-harm, suicide attempts and drug use.23

There are a limited number of services to provide support for LGBTI young people in WA, and often those that do are under-resourced or do not provide services outside the metropolitan area. Given the mental health issues affecting many LGBTI children and young people, and the importance of accessing appropriate and timely support, it is critical that services are expanded and resourced to support the demand.

For further information refer to the Commissioner’s Issue paper on Lesbian, Gay, Bisexual, Trans and Intersex (LGBTI) children and young people.

Children in care, children with disability and children of a culturally and linguistically diverse background are also at greater risk of mental health issues. There needs to be a concerted effort to improve services and supports for these children and their families.

It is important to recognise that while the above brief analysis focuses on different groups of children and young people, there is considerable diversity within groups (e.g. LGBTI, Aboriginal or living in a remote location etc.). All children and young people are different and while membership of one of these groups is influential, there are many other factors which influence a child’s identity and experiences. Thus, policy and programs need to not only recognise the heightened risk for different groups, but also be person-centred and focused on the needs and circumstances of the individual.

Data gaps

There is limited data on the prevalence of mental health issues among WA children and young people. The 2015 Report on the Second Australian Child and Adolescent Survey of Mental Health and Wellbeing (Young Minds Matter) was the most recent survey establishing an estimate of the national prevalence (not WA) of mental health disorders, however, this survey is not planned to be repeated.

The WA Health and Wellbeing Surveillance System collects data on parent and carer reports of children who have ever been treated for an emotional or mental health problem. However, parents and carers often under-estimate the impact and severity of mental health issues and the need for treatment; and there is a known lack of availability of specialised services.24

No recent data is available on the proportion of WA Aboriginal young people experiencing mental health issues, self-harm behaviour or suicidal thoughts. Aboriginal children and young people have a significantly higher likelihood of self-harm and death by suicide. Multiple inquiries have highlighted the need for further programs and services to support Aboriginal children and young people. To improve the lives of Aboriginal young people through better support and service delivery, it is essential that data is collected and reported on the prevalence of mental health issues for Aboriginal children and young people in WA.

There is limited administrative data on service use, occasions of self-harm and suicide of LGBTI children and young people. Sexual orientation, gender identity and intersex status, unlike other demographic characteristics, are not readily identifiable through existing data collection methods (such as coronial records, surveys, administrative data collected by services).25 The lack of data on the prevalence of mental health issues and service use for this cohort of children and young people makes it difficult to effectively improve services and supports for them.

There is no data publicly available on the level of mental health services provided to young people in out-of-home care, even though it is well known these young people are very vulnerable and at high risk of experiencing mental health issues.

There is limited data available on the lived experience of WA’s children and young people with mental health issues. In particular, there has been little research into experiences of particular cohorts of WA children including Aboriginal children and young people, children and young people of parents with a mental illness, young carers, refugee/migrant children, children with chronic health conditions and children in the youth justice system.

The Commissioner’s Speaking Out Survey, scheduled for release in early 2020, will provide some further data on the experiences and opinions of WA’s children and young people regarding their mental health.

Endnotes

  1. Australian Research Alliance for Children and Youth (ARACY) 2008, Technical Report: The Wellbeing of Young Australians, ARACY, p. 58.
  2. Department of Health, Mental Health Division (England) 2010, New horizons: confident communities brighter futures: a framework for developing wellbeing, p. 26
  3. Ibid, p. 26
  4. Commissioner for Children and Young People WA 2011, Report of the Inquiry into the mental health and wellbeing of children and young people in Western Australia, Commissioner for Children and Young People WA, p. 37.
  5. Ibid , p. 36.
  6. Conversano C et al 2010, Optimism and Its Impact on Mental and Physical Well-Being, Clinical Practice & Epidemiology in Mental Health, Vol 6.
  7. Carver CS et al 2010, Optimism, Clinical Psychology Review, Vol 30 No 7.
  8. Commissioner for Children and Young People WA 2011, Speaking out about mental health – The views of Western Australian children and young people, Commissioner for Children and Young People WA.
  9. Ibid, p. 4-5.
  10. Commissioner for Children and Young People WA 2015, Our Children Can’t Wait – Review of the implementation of recommendations of the 2011 Report of the Inquiry into the mental health and wellbeing of children and young people in WA, Commissioner for Children and Young People WA, p. 66.
  11. Centre for Community Child Health 2018, Policy Brief: Child Mental Health – A time for innovation, Murdoch Children’s Research Institute.
  12. Faculty of Child and Adolescent Psychiatry 2010, Prevention and early intervention of mental illness in infants, children and adolescents: Planning strategies for Australia and New Zealand, The Royal Australian and New Zealand College of Psychiatrists, p. 11.
  13. Hosman C and Llopis E 2005, The Evidence of Effective Interventions for Mental Health Promotion, in Promoting mental health; concepts, emerging evidence, practice, World Health Organisation, Victorian Health Promotion Foundation & University of Melbourne, p. 175-176.
  14. Roberts C and Ho M 2008, Aussie Optimism Dissemination Project Report for the Office of Mental Health, School of Psychology, Curtin University of Technology.
  15. Faculty of Child and Adolescent Psychiatry 2010, Prevention and early intervention of mental illness in infants, children and adolescents: Planning strategies for Australia and New Zealand, The Royal Australian and New Zealand College of Psychiatrists, p. 11.
  16. Commissioner for Children and Young People WA 2015, Our Children Can’t Wait – Review of the implementation of recommendations of the 2011 Report of the Inquiry into the mental health and wellbeing of children and young people in WA, Commissioner for Children and Young People WA, p. 35.
  17. WA State Coroner 2019, Inquest into the deaths of: Thirteen children and young persons in the Kimberley region, Western Australia, WA Government, p. 11.
  18. Education and Health Standing Committee 2016, Learnings from the message stick: The report of the Inquiry into Aboriginal youth suicide in remote areas, WA Legislative Assembly, p. 129.
  19. WA State Coroner 2019, Inquest into the deaths of: Thirteen children and young persons in the Kimberley region, Western Australia, WA Government, p. 8.
  20. Ibid, p. 6-7.
  21. Commissioner for Children and Young People WA 2015, Our Children Can’t Wait – Review of the implementation of recommendations of the 2011 Report of the Inquiry into the mental health and wellbeing of children and young people in WA, Commissioner for Children and Young People WA, p. 35.
  22. Morris S 2016, Snapshot of Mental Health and Suicide Prevention Statistics for LGBTI People and Communities, National LGBTI Health Alliance.
  23. Hillier L et al 2010, Writing Themselves in 3: The third national study on the sexual health and wellbeing of same sex attracted and gender questioning young people, Australian Research Centre in Sex, Health and Society, La Trobe University.
  24. Lawrence D et al 2015, The Mental Health of Children and Adolescents: Report on the second Australian child and adolescent survey of mental health and wellbeing, Department of Health, Australian Government, p. 10, 86.
  25. Rosenstreich G 2013, LGBTI People Mental Health and Suicide, Revised 2nd Edition, National LGBTI Health Alliance, p. 6.
Further resources

For further information on the mental health of young people refer to the following resources:

Endnotes

  1. Christensen D et al 2017, Longitudinal trajectories of mental health in Australian children aged 4-5 to 14-15 years, PLoS ONE, Vol 12, No 11.