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Stepped-care model developed to improve youth mental health

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The Mission Australia/Black Dog Institute youth mental health report 2016 found that almost one in four young people aged 15–19 met the criteria for having a probable serious mental illness, with a significant increase from 18.7% in 2012 to 22.8% in 2016 in the proportion of young people meeting these criteria.
 
The report also identified common issues of concern for people in this age cohort contributing to their mental health, including school or study problems, depression, body image, family conflict and bullying. There was also a positive correlation observed between age and likelihood of probable serious mental illness.
 
In 2017, Black Dog Institute piloted the Smooth Sailing service across four New South Wales high schools, providing access to students over six weeks. A total of 59 students aged 13–16 took part in the pilot, the results of which were published in Frontiers in Psychiatry – Child and Adolescent Psychiatry.
 
The study observed that nearly one in five young people (18.6%) reported moderately severe to severe depression or anxiety, requiring follow up from their school counsellors. Of these, four out of five (80%) were new cases that had not previously presented to counsellors for help.
 
Students reported high levels of overall satisfaction with the service, and scores for seeking help, depression and anxiety remained relatively stable or improved over the six-week pilot.
 
By identifying those students who would benefit from mental health counselling, Smooth Sailing was then formally evaluated in a large randomised controlled trial across 22 high schools.
 
‘Smooth Sailing facilitates more targeted and individualised support for students, while also giving school counsellors critical information regarding the students who need help,’ lead author and Black Dog Institute Senior Research Fellow Dr Bridianne O’Dea said.
 
‘The service also helps school counsellors by providing them with a new way to identify and follow-up with students in need.’
 
The service is delivered as online modules in the classroom, where students are assessed and matched to a level of care, based on their reported level of mental health symptoms. Modelled on the principles of stepped care, students are offered tailored treatments of varied intensity and follow up by a school counsellor when necessary.
 
It is the first time this type of model has been trialled in Australian schools.
 
Black Dog Institute reported that overall results from the service so far indicate that one-third of high school students experienced psychological distress and one-quarter had anxiety or depressive symptoms. One in five students reported needing help for their mental health but didn’t seek it, and one-quarter thought an online program could help with their mental health. 
 
Rollout of the Smooth Sailing project’s next steps across 2019–20 include:

• increased training for school counsellors in responding to students in need
• improvements to the school counsellors’ online portal
• improvements to the students’ screening questionnaires and reducing time taken to complete
• increased engagement and interactivity for students to boost participation.

The service will also be offered to new schools over the next year, with an additional 25 schools with limited resources offered free access to the service in 2020 through the Prevention Hub and funded by the Department of Health.

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adolescents depression stepped care youth mental health

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