This paper reports on the response of the Child and Youth Mental Health Service (CYMHS) in Mackay, Queensland, to significant increases in emergency presentations and hospital admissions with young people in psychological distress.
Method
We implemented a multifactor response to meet community need and reduce reactive admissions. Specifically, by addressing patient needs, working with their families, responding to greater mental health services needs and the wider hospital system.
Results
Emergency Department (ED) referrals to CYMHS increased disproportionately over time, rising by 56.4% between 2017 and 2021. Following implementation of the model, admissions in matched 3-month comparison periods fell from 40 in 2021 to 20 in 2024, a 50.0% reduction. Relative to ED activity, admission rates declined from 12.52 to 5.98 per 1000 ED presentations, representing a 52.2% relative reduction. Using Australian inpatient benchmarks, this equated to an estimated 176 bed-days avoided and an indicative cost saving of AUD$449,328 over the observed 3-month period. Service evaluation feedback indicated perceived improvements in staff capability and admission appropriateness.
Conclusion
This study suggests that the interventions provided better access to child and adolescent focussed assessment and treatment services and improved relationships between CYMHS and other units in the health service.
McGorryPGunasiriHMeiC, et al.The youth mental health crisis: analysis and solutions. Front Psychiatr2025; 15: 2024.
3.
CarisonABablFEO'DonnellSM. Increased paediatric emergency mental health and suicidality presentations during COVID‐19 stay at home restrictions. Emerg Med Australas2022; 34(1): 85–91. https://doi.org/10.1111/1742-6723.13901
4.
PereraJWandTBeinKJ, et al.Presentations to NSW emergency departments with self‐harm, suicidal ideation, or intentional poisoning, 2010–2014. Med J Aust2018; 208(8): 348–353.
5.
HiscockHNeelyRJLeiS, et al.Paediatric mental and physical health presentations to emergency departments, Victoria, 2008–15. Med J Aust2018; 208(8): 343–348.
6.
SaraGWuJUesiJ, et al.Growth in emergency department self-harm or suicidal ideation presentations in young people: comparing trends before and since the COVID-19 first wave in New South Wales, Australia. Aust N Z J Psychiatr2023; 57(1): 58–68. https://doi.org/10.1177/00048674221082518
7.
Queensland Family & Child Commission. Joint agency protocol to reduce preventable police call-outs to residential care services, 2018.
8.
JuddJPilkingtonRMMalvasoC, et al.Mental health‐related hospitalisations of adolescents and their contact with child protection services to age 11 years, South Australia: a whole‐of‐population descriptive study. Med J Aust2024; 221(10): 540–545. https://doi.org/10.5694/mja2.52489
9.
Australian Bureau of Statistics. Mackay population report 2022. Australian Bureau of Statistics, 2022.
10.
Mackay Hospital and Health Service. Local area needs assessment summay report, 2022.
11.
CarrA. Family therapy and systemic interventions for child‐focussed problems: the evidence base. J Fam Ther2025; 47(1): e12476. https://doi.org/10.1111/1467-6427.12476
12.
PerkesIEBirmaherBHazellPL. Indications for psychiatric hospitalization of children and adolescents. Aust N Z J Psychiatr2019; 53(8): 729–731. https://doi.org/10.1177/0004867419835930
13.
FugglePFairbairnJFonagyP. Outcomes for Adaptive Mentalization Based Integrative Treatment informed care for adolescents using a deployment-based approach. Psychol Psychother Theor Res Pract2024; 97(S1): 91–104. https://doi.org/10.1111/papt.12496
14.
Vermeulen-OskamEFranklinCVan’t HofLPM, et al.The current evidence of solution-focused brief therapy: a meta-analysis of psychosocial outcomes and moderating factors. Clin Psychol Rev2024; 114: 102512. https://doi.org/10.1016/j.cpr.2024.102512
15.
PerkinsR. The effectiveness of one session of therapy using a single‐session therapy approach for children and adolescents with mental health problems. Psychol Psychother Theor Res Pract2006; 79(2): 215–227. https://doi.org/10.1348/147608305X60523
16.
PerkinsRScarlettG. The effectiveness of single session therapy in child and adolescent mental health. Part 2: an 18‐month follow‐up study. Psychol Psychother Theor Res Pract2008; 81(2): 143–156. https://doi.org/10.1348/147608308X280995
17.
IndigDGearCYorkA. The role of inpatient care for children and adolescents with moderate-to-severe mental disorders: an Evidence check. The Sax Institute, 2017.
18.
ShepperdSDollHGowersS, et al.Alternatives to inpatient mental health care for children and young people. Cochrane Database Syst Rev2009; 2009(2): Cd006410. https://doi.org/10.1002/14651858.CD006410.pub2
19.
MillerSDDuncanBLBrownJ, et al.The outcome rating scale: a preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. J Brief Ther2003; 2(2): 91–100.
20.
BrazelMAllisonSBastiampillaiT, et al.Child and adolescent mental health services in Australia: a descriptive analysis between 2015–16 and 2019–20. Australas Psychiatry2023; 31(4): 445–451. https://doi.org/10.1177/10398562231165845
21.
LohrWDJawadKSWoodN, et al.Factors associated with child and youth mental health readmissions from a US national database. JAACAP Open2024; 2(3): 170–179. https://doi.org/10.1016/j.jaacop.2023.12.001
22.
MacDonaldKLaporteLDesrosiersL, et al.Emergency department use for mental health problems by youth in child welfare services. J Can Acad Child Adolesc Psychiatry2022; 31(4): 202–213.
WeiszJR. Bridging the research-practice divide in youth psychotherapy: the deployment-focused model and transdiagnostic treatment. Verhaltenstherapie2015; 25(2): 129–132. https://doi.org/10.1159/000430432
25.
SavaglioMO’DonnellRHatzikiriakidisK, et al.The impact of community mental health programs for Australian youth: a systematic review. Clin Child Fam Psychol Rev2022; 25(3): 573–590. https://doi.org/10.1007/s10567-022-00384-6
26.
GlissonCSchoenwaldSKKelleherK, et al.Therapist turnover and new program sustainability in mental health clinics as a function of organizational culture, climate, and service structure. Adm Policy Ment Health2008; 35(1-2): 124–133. https://doi.org/10.1007/s10488-007-0152-9
27.
GhateD. From programs to systems: deploying implementation science and practice for sustained real world effectiveness in services for children and families. J Clin Child Adolesc Psychol2016; 45(6): 812–826. https://doi.org/10.1080/15374416.2015.1077449
