Kristy Muir

‘They don’t treat you like a virus’: youth-friendly lessons from the Australian National Youth Mental Health Foundation

Young people experience high rates of mental health problems, but very few access professional mental health support. To address the barriers young people face in accessing mental health services, there is growing recognition of the importance of ensuring services are youth-friendly. Indeed, almost a decade ago, the World Health Organisation developed a youth-friendly framework for services to apply. Yet, this framework has rarely been evaluated against health initiatives for young people. This article begins to address this gap. Using 168 semi-structured, qualitative interviews with young service users, this paper explores the extent to which the Australian National Youth Mental Health Foundation, also called headspace, applied the WHOs youth-friendly framework which emphasises accessibility, acceptability and appropriateness (AAA). It argues that headspace was largely successful in implementing an AAA youth-friendly service and provides evidence of the importance of tailoring services to ensure they are accessible, acceptable and appropriate for young people. However, it also raises questions about what youth-friendly service provision means for different young people at different times. The findings suggest that youth friendliness should be applied across different stages of interaction (at initial engagement and in the ongoing relationship between patient and clinician) and at different levels (the environment the care is provided in, within policies and procedures and within and between relationships from receptionists to clinicians).

Intellectual Disability and Complex Intersections: Marginalisation under the National Disability Insurance Scheme

This paper questions whether Australias new disability support regime, the National Disability Insurance Scheme (NDIS), can meet its aims for people with disabilities who also experience complex social disadvantage, using the examples of people with intellectual disabilities from cultural and linguistically diverse backgrounds and those who cycle in and out of the criminal justice system. The paper undertakes a critical analysis of the proposed eligibility requirements under the NDIS and assesses the risks of marginalisation in the proposed approach for people with intellectual disabilities who also experience other complex individual and social disadvantage, and begins to ask, “Will the NDIS meet its aims if it does not address these complexities?” The analysis suggests that under the draft rules for eligibility the onus is on individuals to prove their eligibility for supports funded by the NDIS on a case-by-case basis and, moreover, to prove that receiving such support will reduce their future depende...

‘I didn’t like just sittin’ around all day’: facilitating social and community participation among people with mental illness and high levels of psychiatric disability

People with mental illness can be profoundly disabled and at risk of social exclusion. Transitional models of supported housing have limited effectiveness in improving community participation. Stable, individualised psychosocial housing support programmes have been found to assist in improving mental health and decreasing hospitalisations, but little is understood about whether or how these programmes facilitate social and community participation. This article argues that, if certain supports are available, supported housing models can assist people with high levels of psychiatric disability to participate meaningfully in the community. To make this case, the article uses findings of a longitudinal evaluation of a supported housing model in Australia: the Housing and Accommodation Support Initiative Stage One (HASI). HASI is a partnership between the New South Wales Government Departments of Health and Housing and non-government organisations. It is a coordinated approach that provides clients with housing and community-based clinical support, as well as support with daily living skills and community participation. An analysis of questionnaire, database, interview and clinical data is used to demonstrate how HASI contributes to increased social and community participation. The article concludes with policy implications for supported housing models that aim to facilitate meaningful community participation for people with mental illness.

Tricks of the Trade in Community Mental Health Research: Working With Mental Health Services and Clients

The complexities of research in the community mental health sector are seldom acknowledged in existing literature; this article attempts to address this void. It presents the methodological challenges experienced in the longitudinal evaluation of the Housing and Accommodation Support Initiative—a program that supports people with chronic mental illness toward long-term recovery. The evaluation provides a case study for understanding methodological problems in community mental health research, which include working with organizations that experience high staff turnover; staff members who have large caseloads; and clients who have chronic mental illness. Although not applicable to all research designs, the suggested strategies highlight the importance of innovation, flexibility, and balance between research theory and practical limitations when conducting community mental health research.

Whose responsibility? Resilience in families of children with developmental disabilities

Families with children with disabilities are at higher risk of stress, financial disadvantage and breakdown. In recent decades, research and policy have shifted focus from these problems to a strengths-based approach, using concepts such as family resilience. By definition, resilience is the ability to cope in adverse circumstances, suggesting a reliance on the individual. If this is the case, then to what extent does ‘family resilience’ place another burden of responsibility onto families? Whose responsibility is family resilience? This paper begins to answer this question using interviews with parents of children with developmental disabilities based in New South Wales, Australia.

Early impacts of Communities for Children on children and families: findings from a quasi-experimental cohort study

Background There have been few evaluations of national area-based interventions. This study evaluated the early effects of Commmunities for Children (CfC) on children and their families and whether the effectiveness differed for more disadvantaged families. Methods A quasi-experimental cohort study in socioeconomically disadvantaged communities in Australia. Mothers of children aged 2–3 years participated at wave 1; 1488 children in CfC communities and 714 children in comparison communities. Outcome measures included child health and development, family functioning and parenting, and services and community. Results After controlling for background factors, there were beneficial effects associated with CfC. At wave 3, in CfC areas children had higher receptive vocabulary (mean difference (MD) 0.25, 95% CI −0.02 to 0.51; p=0.07), parents showed less harsh parenting (MD −0.14, 95% CI −0.30 to 0.02; p=0.08) and higher parenting self-efficacy (MD 0.11, 95% CI 0.00 to 0.21; p=0.04). Fewer children living in CfC sites were living in a jobless household (OR 0.56, 95% CI 0.32 to 0.95; p=0.03) but childrens physical functioning (MD −0.26, 95% CI −0.53 to 0.00; p=0.05) was worse in CfC sites. For children living in households with mothers with low education there were reduced child injuries requiring medical treatment (MD −0.61, 95% CI −0.07 to −1.13; p=0.03) and increased receptive vocabulary (MD 0.57, 95% CI 0.06 to 1.08; p=0.03). Conclusions CfC showed some benefits for child receptive vocabulary, parenting and reducing jobless households and two adverse effects. Children living in the most disadvantaged households also benefited.

How can non-clinical case management complement clinical support for people with chronic mental illness residing in the community?

The recovery of people with chronic mental illness who reside in the community requires integrated support services. Yet evidence of poor collaboration in the mental health system abounds and there is little understanding of how non-clinical case managers can work effectively with clinical services. This article analyses an example from the mental health Housing and Accommodation Support Initiative in Australia. Using interviews (42 consumers, family members and mental health workers) and consumer care plans (20), the article explores how clinical and non-clinical case managers worked together in consumer care planning and examines the perceived influence of support. The research found they worked effectively in care planning when the planning was consumer-driven; there was active participation from consumers, non-clinical and clinical case managers; and when planning was treated as a process, with incremental goals, reflective practice, as well as shared understanding and commitment to the collaboration.

Young people’s education biographies: family relationships, social capital and belonging

ABSTRACT This paper examines complexities and interdependencies of key family relationships which anchor young people’s educational biographies. It is well recognised that young people’s education pathways in late modernity are strongly dependent on their ability to draw on the range of resources available, and that socio-economic status and family resources play a central role in this process. Less is known about how such relationships anchor young people’s education biographies. Drawing on theories of social capital and belonging in dialogue with qualitative interviews, and situated in studies of rural youth and education, this article considers how young people themselves talk and make decisions about their education in relation to complex family connections. These connections, contestations and negotiations between young people and central family members highlight how the late modern economy impacts on young people’s intimate relationships, and sheds light on the ongoing work of youth to resolve such tensions around their schooling in daily life.

Complementing or conflicting human rights conventions? Realising an inclusive approach to families with a young person with a disability and challenging behaviour

United Nation’s conventions exist to help facilitate and protect vulnerable people’s human rights: including people with disabilities (Convention on the Rights of Persons with Disabilities, 2006) and children (Convention on the Rights of the Child, 1989). However, for some families where a family member has a disability, there may be inherent conflicts in meeting stand-alone human rights conventions. These conventions should work together to ensure that young people with disabilities and challenging behaviour and their parents and siblings all have equal rights to full participation in social, economic and civic life. Yet service system deficits mean that this is not always the case. This paper argues that governments need to provide a whole of family and community support approach to ensure the human rights of all family members are met. This is a transnational complex ethical, moral and human rights issue that needs to be debated and addressed.

Are you really Financially Excluded if you Choose not to be Included? Insights from Social Exclusion, Resilience and Ecological Systems

Around one in five people in developed countries are ‘financially excluded’. But how meaningful is this when the current definition does not differentiate between those who choose to be excluded and those who are forced to be? This conceptual paper draws on frameworks from social exclusion, resilience and ecological systems theory to critique the current definition of financial exclusion and to introduce an alternative concept. The paper argues that the emphasis of extant literature on an access-point approach has isolated the context surrounding financial exclusion and contributed to simplifying the phenomenon. It puts forward the need for a change in the way financial exclusion is conceptualised in developed countries to take broader contextual settings and a more holistic approach into account and it suggests that a shift to financial resilience may be a way forward.