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ANGE:

From Schwartz Media, I’m Ange McCormack. This is 7am.

If a child experiences a complex mental health condition like psychosis, everyone would agree that someone at such a young age needs careful and considered care, and if drugs are prescribed, the benefits should outweigh the risks.

But there are fears that isn’t always happening in Australia, and that growing demand for mental healthcare means the people who need the most specific treatment aren’t always getting it.

Today, contributor to The Saturday Paper, and author of ‘The One Thing We’ve Never Spoken About’ Elfy Scott, on how mental health care for young people is becoming an issue of equality.

It’s Tuesday, March 26.

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ANGE:

Elfy, we're going to talk about how children who are experiencing severe mental health issues are treated in Australia. To start off with, if a child is going through something like a psychotic episode, what on paper should happen to them?

ELFY:

Yeah, sure. I think it's worth mentioning from the outset that a child, particularly before puberty, experiencing the symptoms of a complex mental health condition like psychosis is actually quite rare and is very rarely diagnosed. But for children who are experiencing these sort of onset symptoms of a complex mental health condition, there are a couple of different points of entry. So they could present to a GP and get referred to a psychologist or a psychiatrist. There's a possibility that they would need to be prescribed medication, and specifically antipsychotic medication if they are presenting with symptoms of psychosis. But also ideally, I mean, if a child is registered as having these kinds of symptoms, they would be referred to a kind of early intervention program, which would involve things like peer support or things like counselling. And if it's necessary and their symptoms escalate, that child would then be potentially referred to a hospital or they would be given medication after about 1 to 2 weeks if their symptoms don't seem to be abating at all.

ANGE:

Okay, so it sounds like there's definitely some kind of infrastructure or, like, broad plan in place for when this scenario, even though it's rare, happens. But, you know, when we're talking about kids and we're talking about mental health issues, every case is obviously going to be really different and I can imagine it's not always straightforward, treatment wise. So what can happen when a child is severely mentally unwell in Australia?

ELFY:

Obviously it varies, from family to family and child to child, depending on their particular circumstances. But I do want to provide you with one example, which is the story of a young woman called Tanya. And I've been speaking with her older sister, Tina. And now Tina got in contact with me because she has grown more and more concerned in recent years about what happened to her little sister.

Now, when Tanya was 12 years old, she was first admitted to hospital for psychiatric care. Tanya had been exhibiting some troubling behaviour. She had been sort of lagging behind at school, and her parents had noticed that she was acting a little bit out of the ordinary.

So Tanya had been recommended to go to therapy. That couldn't happen because her parents said that it was just... the out-of-pocket costs was simply too much. It just wasn't accessible for their family.

Tanya was then admitted to psychiatric care in a hospital, because she seemed to be, as Tina explains, experiencing the symptoms of some kind of mania. Within two weeks, Tanya had been transferred to a mental health unit at Westmead Children's Hospital. She was placed on lithium, a medication used to treat bipolar disorder, and Olanzapine, which is an antipsychotic medication.

So Tanya was 12 years old when she started receiving these medications, which is not totally out of the ordinary, but over the years, after Tanya first had that admission, Tina says that she kept receiving higher and higher doses of these antipsychotic medications, they just weren't working for her. She was in and out of hospital, and the dosages just kept going up and up. And Tina was really distressed, obviously, by witnessing this in her sister. And she said that, you know, even at one point she was visiting her sister in a psychiatric institution and one of the doctors pointed to a rather large man in middle age and said, that man is on a quarter of what Tanya is on in terms of medication.

And then unfortunately in November of 2016, Tanya actually died in her sleep in a psychiatric unit at the age of 23.

ANGE:

And that's a really sad and unfortunate story. What answers do Tanya's family have about how she died?

ELFY:

Well, there was a coronial inquest, following Tanya's death and the report that came out of that proposed several medical reasons for why she died. But unfortunately, the capacity of that inquest couldn't look at, you know, her family's primary concern, which was their belief that Tanya had been placed on too many psychotropic medications from too young an age. And now, in the wake of that inquest and following her sister's death, Tina is asking a lot of questions about, I guess, the impacts that these drugs have on young developing brains. And when I was speaking to her and she was recounting this incredibly heartbreaking, distressing story of her sister's life, she likened the medications that her sister was being prescribed as using surgical tools that are blunt and infected in an operation. And I just think that's the most potent metaphor for what she saw, because she said that when she visited her sister in psychiatric units, you know, she saw her sister in these catatonic states. She saw her sister lose her personality. She saw her sister distressed in a way that she hadn't seen somebody before, and she has witnessed psychosis in other family members before. She's seen other family members being placed on antipsychotic medication. And she said it was like watching the light go on in them. But she just felt like there was something wrong with the way that Tanya had been treated throughout her teenage years, and the amount of medication that she'd been placed on.

ANGE:

So what do we know about the medications that Tanya was on? And also, what do we know about how those types of medications are being used in Australia?

ELFY:

Well, I think we should start off by kind of defining the kind of medications that I'm speaking about. So when I refer to psychotropic medications, I'm talking about medication that's used to treat anything from ADHD to anxiety to psychosis or depression. And when we are talking about psychotropic medication prescriptions for people under the age of 18, there are some that are indicated by the TGA for use. So obviously ADHD medication has proven to be incredibly effective for some children. But then I think it's also worth pointing out, and I'm pretty confident that a lot of Australians wouldn't be aware of this, that many of these medications are being prescribed off label to people under the age of 18, basically meaning that they're not indicated by the TGA for use in people under the age of 18. So all antidepressants for young people are being prescribed off label. And research indicates that there's been this pretty significant rise in the amount of prescriptions of psychotropic medication for children and adolescents in recent years. So there are concerns about things like metabolic conditions that can come up for children using antipsychotics. There is some data that indicates that the use of antidepressants in children and adolescents can increase suicide risk in the first couple of weeks that they're taking that medication. I think the point is, overall, that a lot of this is just largely untested.

And I think it's worth saying that these medications are responding to a real world increase in mental distress for young people. We know that young people are experiencing mental health conditions at a rage that is genuinely worrying and medication can help children to manage those symptoms. But then I guess there's also this question that's being raised by people like Tina, about the reasons that these medications are being prescribed and whether or not they're always appropriate, and if in fact, they can cause long term harm.

ANGE:

After the break, why are doctors prescribing psychotropic medications to kids so often?

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ANGE:

Elfy, if there are concerns being raised about how these medications are being prescribed to children and young people, when they present with mental health issues, I'm wondering what's exactly going on that's causing doctors to make these decisions? What's leading us to this space we're now in, where there are concerns being raised over prescription use in kids?

ELFY:

Yeah, this is a really interesting one because I think that it's worth pointing out, but it's not as though doctors are acting maliciously or negligently. I think that a lot of researchers are saying that it's really the failures of the mental health care system at large that are leading to this increase in prescriptions, in some cases. So, for example, Professor Pat McGorry and Doctor Ian Hickie, the two of the country's leading mental health experts, and I spoke to both of them. And both of them, you know, agree that there have been these explosions in demand for mental health services from young people, and that's led to gaps in delivering quality care. So for example, in terms of demand for mental health care services, I saw data come out of the ABS that between 2022 and 2023, 40% of people who needed psychiatric care either deferred or didn't end up going to an appointment purely because of either prohibitive costs or really long wait times which is really concerning and it's a huge indication of how much this mental health demand has reached crisis point in Australia. And when we're talking about access to psychiatric services, we also have to acknowledge that people who live in regional and rural areas, as well as people who live in lower socioeconomic areas, simply don't have the access to the same kind of psychiatric services and psychological services that people in better off areas do. So say you're living in the eastern suburbs of Sydney and you go to your GP and you say that you are experiencing the symptoms of a complex mental health condition, I've been told by doctors there that they could send me to 100 different people. But if it came down to being a person in western Sydney, there would be a select amount of people who could deal with those issues and you certainly wouldn't expect that you can see them for as long term as you could if you had the financial resources at your disposal to keep paying for those, for those sessions out of pocket.

ANGE:

So I guess what you're talking about here is that this is of course a mental health issue, but it's actually kind of an equality issue. You know the poorest kids, the less well-off kids, are getting more limited and sometimes worse care. In a place like Australia that's obviously meant to offer free, equal, high quality health care, how have we ended up here?

ELFY:

Look, there are so many historical factors at play here. So we've seen this massive increase in demand for the mental healthcare system in recent years that's been exacerbated by things like the pandemic. The way that Professor Patrick McGarry put it to me was that the whole system's just been smashed. And he said that, you know, even since he had established the youth mental health service Headspace, they've actually seen a 50% increase in demand. But at the same time, we've also seen this kind of erosion of services, there's this constant lack of funding. And there is also this lack of people who are actually training up to become psychiatrists and psychologists. And when I was researching my book a couple of years ago and I was speaking to psychiatrists about this phenomenon, one person told me that, you know, it's such a devastating sector to work in now, there's so little money, it's so hard, those mental healthcare practitioners are working themselves to the bone with so little reward. And it's de-incentivising a whole generation of people who would otherwise be training to work in the mental health care sector. So the worse it gets, it's sort of like this cycle that self perpetuates, and people are less and less willing to enter the industry.

ANGE:

And so Elfy, for someone like Tina, who's the sister of Tanya who we were speaking about earlier, she obviously has really big concerns about how our healthcare system is dealing with vulnerable young people and kids. What does someone like Tina want to see change, to make sure young people and children get the best care possible?

ELFY:

What Tina stressed to me over and over again was that she didn't want to see the restriction of antipsychotics or any other psychotropic medications used in young people, and she wasn't saying that there was no place for them. She actually worked in the pharmaceutical industry, and she said multiple times, I believe in the power of pharmaceuticals to help treat people.

But she also just expressed this concern about the way that medications were being prescribed to children in that, she really wonders about what her sister's life might have been like if her treatment hadn't gone down that route. And I think when Tina is expressing her concern around these kinds of things, ultimately it really does reflect back on these broader scale issues in Australia's mental healthcare system. And when you speak to experts like Professor Patrick McGorry or you speak to Doctor Ian Hickie, what they'll say again and again is that we need this massive reform in our mental healthcare system that's just not happening because there's no funding and there's not enough attention being paid to these people who are in dire need of help.

ANGE:

Elfy, thanks so much for your time today.

ELFY:

Thank you.

ANGE:

If you or someone you know needs help, you can call Lifeline on 13 11 14. Children and young people under the age of 25 can get help from the Kids Helpline on 1800 55 1800.

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ANGE:

Also in the news today…

The retirement of Greens senator from Victoria Janet Rice, has led to a reshuffle, with David Shoebridge picking up responsibility for Home Affairs, Immigration, Citizenship and Multicultural Affairs, and Nick McKim taking over Rice’s role as spokesperson on Forestry.

And,

Tim Wilson has been preselected as the candidate for the Liberal Party in the Victorian seat of Goldstein, setting up a rematch from the 2022 election contest with Independent MP Zoe Daniel.

I’m Ange McCormack, this is 7am. Thanks so much for listening, we’ll be back again tomorrow.

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