Improving mental health services for young adults: greater awareness of the mental health needs of young adults is needed, along with more responsive and age-appropriate services, according to a recently published report.

Young adults need more responsive mental health services focused on their individual needs, according to a recently released Mental Health Commission report.

Young people aged 18-29, who are one of the largest groups of service users, can be driven into mental health crises because they are not accessing mental health services early enough, the report says. "Earlier help would mean fewer young people being taken to acute inpatient services in a state of crisis."

Entitled Journeys of Despair, Journeys of Hope: Young Adults Talk about Severe Mental Distress, Mental Health Services and Recovery, the report, published in June, is based on in-depth interviews with 40 young people. Half of them were men and half women, with 17 identifying as Pakeha, 14 as Maori, seven as Pacific and two as Asian. Around 18,000 young adults aged 1829 use mental health services each year, 7000 of them for the first time.

During their contact with mental health services, two thirds of participants were give a diagnosis that fell into the psychosis spectrum group, including schizophrenia and bipolar illnesses, while the remainder were given non-psychosis diagnoses, including "personality", eating or post-traumatic stress disorders.

Half the participants who spoke about their childhoods during the research, talked about growing up in abusive family environments and/ or having traumatic abuse experiences. Many of the participants lacked a secure family life offering a sense of safety and predictability. Few had the opportunity to communicate their grief and distress to trusted adults and many experienced poverty and deprivation. Sexual abuse typically occurred within the family environment.

Lack of communication within the family was another prominent childhood/young teen theme connecting to later mental health difficulties. Most spoke of excessive use of drugs and alcohol during their early teens as a means of coping with distress and depression. Other stressors included being bullied at school, being harassed by teachers and getting in with a "bad crowd".

Researchers Hilary Lapsley and Heather Barnett, in the concluding chapter of the 112-page report, stressed the need for appropriate and early drug and alcohol education and intervention, rather than later, in the teenage years. They noted that serious distress occurred over a long time period, without effective help being given. What these young people needed, they said, was emotional and practical support, and access to peers and older adults who could listen to and validate their experiences, and who did not stigmatise mental health conditions. Often the help young people did receive from primary health and counselling services was insufficient and unsuccessful.

Neglected mental health problems

Lapsley and Barnett argue that the participants were driven into crisis unnecessarily. "Despite warning signs over a tong period of time, effective mental health help had not been made available to them. Mental health problems, without attention, can suddenly blow up into a crisis." They also state that mental health services, in their "gate-keeping role", effectively prevent access to services by people who are outside the three percent of the population who have the most severe problems, and who are therefore entitled to services. "Those with symptoms of non-psychotic spectrum disorders had a far harder time gaining access." However, they also concede that mental health services at present most probably could not cope if services were offered to all who wanted them.

After crisis and crisis assessment, two-thirds of the study participants went on to acute adult inpatient units, many compulsorily admitted. Although the crisis was lessened, participants reported that the experiences of adult inpatient units were not conducive to recovery. In fact, acute stays re-traumatised them. Those who went to "acute alternatives" fared better than those who went to adult inpatient units. For most participants, participation in non-acute services was the first step towards recovery.

Other trends noted in the report were that Pakeha women were far more likely to seek help than Maori, Pacific or Asian men; Pacific participants and men were more likely to become inpatients than others; and those who made most progress were more likely to be Pakeha, women and from the "non-psychosis group and to have avoided the adult inpatient experience.

Culturally based services provided some different pathways for Maori and Pacific participants, and were appreciated, but they did not provide early intervention or avert hospitalisation. Cultural services were not notably present during inpatient stays.

Young adults in adult inpatient units did not generally get sufficient attention or positive interaction from nursing staff, and this replicated, for many, their feelings from childhood onwards of being unable to communicate deep feelings or talk about what really mattered. They did not receive psychological help, which they would have appreciated.

Treatment in smaller settings needed

The study suggests that young adults in crisis would thrive if they were able to receive treatment in smaller, more home-like settings with peers, where psychological treatments were provided. "Many of our participants would have benefited from good child and adolescent mental health services. Good transitions must be provided, where necessary, between child and adolescent services and the services young adults use. A range of community-based alternatives to acute mental health services, such as home-based treatment and recovery houses is required. Services must be able to respond as soon as a person or their family indicates they need help, rather than waiting until there is a crisis," the researchers conclude.

Copies of the report are available from the Mental Health Commission, PO Box 12 479, Wellington, email [e-mail].