Mind Moves:When it comes to reaching out for help, some young people simply don't want to go there. They opt out, lose touch with their education, their work, their family and their friends, as they seem to give up on their lives altogether.
It is easy to be smug and say this is their choice, that it's up to them to avail of whatever services are in place. It's easy to locate the problem in their failure to seek help, rather than in our failure to make our services relevant and attractive to them.
The multidisciplinary Intensive Mobile Youth Outreach Service (IMYOS) was set up to respond to this scenario. It is part of a larger service, ORYGEN, in Melbourne, which is a world leader in youth mental health. It has a reputation for bringing the best thinking and practice to working with young people (15-25 years of age), who are at risk of developing mental illness.
IMYOS arose out of a growing community concern for the needs of young Australians who were homeless, suicidal, unemployed or abusing drugs. IMYOS is a seven-person team - comprising two psychologists, two social workers, an occupational therapist, a nurse and a half-time psychiatrist - that provides an intensive outreach mental health service to young people and their family. It also looks at where the young person is unable to engage with traditional mainstream clinical services.
The young people with whom the IMYOS works, are typically experiencing a complex range of social, familial and psychological problems which have left them in severe distress. Many of them have extensive histories with multiple services and they are often not attending school or any other day programme. They are likely to be experiencing family conflict and may live outside the family home. No matter how painful their crisis, they find it virtually impossible to reach out for help.
Young people who are difficult to engage are not bad or hopeless, but rather have limited, if any, experience of trusting relationships and therefore tend to avoid them. Many of them have experienced trauma or abuse and the relationships they have managed to maintain are often chaotic. IMYOS provides these young people with a stable relationship and empowers them to re-engage constructively with their world.
It works on three levels: with the young person, their families and the systems of care that surround them. A recovery plan is evolved with each young person, with special attention to safety concerns, and this is shared with all parties concerned.
A difficulty that is often encountered by families and clinicians, is that the mental health system can be very individualistic in its view of symptoms and treatments. IMYOS works hard to involve family members in all aspects of its services. Family involvement ensures a shared understanding of the young person's experience and prevents families feeling neglected, excluded or blamed for their child's problems.
Each member of the team carries a caseload of eight or nine young people and makes one or two visits weekly to the person, in addition to a session with their families and any other agency that is active in the young person's life.
IMYOS has a policy of seeing a young person wherever they feel safest. For some, this will be at home, but for many, meetings occur in a more neutral setting.
Karen, an occupational therapist with the IMYOS team, says she often makes the most progress therapeutically with young people, while driving around in her car. For these young people, traditional clinic-based therapy is too intense and quite frightening. In the car, they can have the radio on in the background, look out the window and use these distractions to control the intensity of the conversation.
Karen's only rule is that while they can choose the music, she controls the volume.
She clearly has a passion for her work and takes pride in the fact that outcome evaluations of the IMYOS service confirmed an 80 per cent success rate. Playing devil's advocate, I suggested to her that the IMYOS programme was a poor use of resources, that she and her team could see four or five times the number of young people in their office as in their clinics.
Karen acknowledged these issues, but she emphasised that the young people and families served by IMYOS were the people who most needed services and who might otherwise never get help.
Outreach also reduces the need for hospital admission and brings the focus of intervention to where it is most needed - to the community where the young person lives, and to families and agencies who are critical in their lives.
A key advantage to outreach is that the benefits from therapy are more likely to be maintained in the long term, as the young people are engaged in their natural environment, and supported in dealing with the issues that have most impact on their lives.
IMYOS is just one of the many creative services run by ORYGEN. Irish people have reason to feel some measure of pride for ORYGEN's considerable influence on worldwide innovations in youth mental health. Its founder and current director is "one of our own", Prof Pat McGorry, a Dublin-born psychiatrist.
Tony Bates is chief executive of Headstrong - The National Centre for Youth Mental HealthMind Moves
