A team of mental health professionals in South Eastern Sydney Local Health District (SESLHD) is implementing best practice mental health support for children under 12.
According to the National Children’s Mental Health and Wellbeing Strategy,1 50% of all adult mental health challenges emerge before the age of 14 years, with approximately 13.6% of Australian children aged 4-11 years having a diagnosed mental illness.2 For Aboriginal children aged 5-17 years, suicide is the leading cause of death.3
Despite this prevalence, children and young people aged 0-12 years who experience mental health problems report the lowest rates of use of specialist mental health services in Australia.4 In SESLHD, the provision of mental health support for under 12s and their carers varies by their geographical location. The support provided to families is currently a ‘postcode lottery'; it deviates from evidence-based practice recommendations and is not always informed by contemporary strategic frameworks that prioritise early intervention and vulnerable population groups.
Best practice mental health support
This project aims to provide equitable access to effective, best practice mental health support across SESLHD for under 12s, while reducing confusion for caregivers and referrers. This project will help to provide a more positive consumer experience, improve staff experience and confidence, and reduce long-term costs to the health system. The project team conducted an extensive diagnostic investigation to better understand the reasons for inequities in service provision seen across the district for under 12s.
They completed an initial high-level process mapping activity with three child and adolescent mental health (CAMHS) teams and one population and community health team that works specifically with under 12s. This was followed by surveys with staff, consumers and key referrer groups. The project team also conducted file audits, along with an exploration of demographic data, service activity data and staffing vacancy rates. The team gathered additional information via site visits and consultation with other LHDs to benchmark their approach. These activities revealed the following findings:
- There was significant variance between the north and south of the district: the north had five times as many children seeking services, with 12% of referrals to Aboriginal children and their families compared to 4% in the south.
- Approximately 50% of the issues identified occurred during the intake phase of the consumer journey, suggesting challenges with decision making processes around service access.
- Service inclusion and exclusion criteria were unclear and inconsistently applied, demonstrating clinical variation and individual clinician-led decision making.
- Adolescent symptom severity and distress was prioritised over younger children’s externalising behaviours such as aggression, rule-breaking or impulsivity that may be indicative of underlying mental health challenges.
- Staff did not feel confident working with under 12s given they tended to see more adolescents.
- Staff did not feel confident delivering culturally safe care to Aboriginal children and families.
Creating a developmentally appropriate, consistent and culturally safe service
The project team identified that the root cause of service inequities was that referral pathways, intake criteria and triage processes were being impacted by differing governance structures and service priorities. Inequity of access to services is a missed opportunity for early intervention. Limited exposure to this age group also results in staff not fully developing their skillset across the age range.
The project team held several solution design workshops that involved 35 staff and resulted in the generation of 40 potential solutions. From there, the team invited staff, consumers, referrers and key stakeholders to vote on these solutions. This resulted in two solutions chosen:
- Establish a consistent and developmentally appropriate referral and criteria model for mental health service provision to children and adolescents in SESLHD that prioritises under 12s and Aboriginal families.
- Improve access for Aboriginal children under the age of 12 and their families in SESLHD to culturally safe mental health support by streamlining referral processes, providing safe cultural spaces and options for care delivery and access to well supported staff.
A review of the history of change implementation in the service revealed challenges in the areas of reinforcement and involvement. The project team embedded a change strategy within the implementation phase to acknowledge and help overcome these challenges. The team has also established working parties including CAMHS staff across the district to develop and progress these solutions as of February 2025.
Looking towards a standardised referral model
Evaluation results will be available by December 2025. The project team is currently implementing several quick wins, including providing CAMHS staff with violence, abuse and neglect training, as well as advanced cultural awareness training for non-Aboriginal staff. Expected outcomes include:
- A standardised referral and priority criteria model that prioritises under 12s and Aboriginal families.
- Improved access for Aboriginal children under 12 and their families to culturally safe mental health support.
- Improved staff experience through increasing confidence in best practice care and cultural competency; and increasing support for staff so they feel professionally fulfilled.
- A reduction in long-term healthcare costs by improving access and optimising health outcomes earlier, reducing the burden on mental health services later in life.
View this project's poster from the Centre for Healthcare Redesign graduation May 2025.
