The children's crusader
The new Australian of the Year, Fiona Stanley, intends using the accolade to raise awareness about the epidemic of childhood mental illness. Ruth Pollard reports.by Ruth Pollard
January 29 2003
Sydney Morning Herald
It is all about prevention. As Fiona Stanley sees it, with one in five Australian teenagers experiencing significant mental health problems, there are just not enough treatment services to cope with the demand.
More care, please ... Professor Fiona Stanley, with friends at Burswood Park in Perth, says social changes are impacting on children. Photo: Dominic O'Brien
Instead, resources must be focused on preventing these illnesses from developing, intervening in a child's life before they sink into mental illness or become lost in a life of crime.
In the tried and true tradition of seatbelt education campaigns, HIV/AIDS awareness and Slip, Slop, Slap skin cancer prevention, Professor Stanley, the new Australian of the Year, wants mental health firmly on the preventative public health agenda.
It is a campaign she'll begin from an almost standing start, despite the quality research her Perth-based Telethon Institute for Child Health Research has produced over the past decade.
Public health spending on mental health in Australia is stuck at 6 per cent - less than half the rate of governments in Britain, Canada and New Zealand.
And in NSW, 20 years after the Richmond report into mental health services in NSW recommended "deinstitutionalisation", the state still lacks adequate community and family support services to care for those with mental illnesses outside institutions.
"I don't think we are overstating the point," Stanley says. "Children and adolescents are experiencing significant psychosis, schizophrenia, depression, anxiety - the rates in Australia are rising the same as they are in every country in the Western world."
Stanley says, with some incredulity, that it has only been in the past 20 years that we stopped relying on death certificates as a measure of our health. Take attempted and completed suicide as an example: more males commit suicide, more females attempt it. "Death certificates don't measure that," Stanley says.
What they do measure is falling children's death rates, but this alone is a poor indicator of health. "When we start to look at mental health, we have been shattered by the high levels."
Stanley is an epidemiologist - she measures, describes and explains the occurrence of disease in populations, using the data to argue for the enhancement of health and wellbeing in the community.
She points to several key, marked changes in our society over the past 50 years that have influenced the mental wellbeing of children.
Divorce is an obvious one. In the 1950s, less than 10 per cent of marriages involving children ended in divorce - now that rate is nearly half. "At any age that has a major impact on children, because of the kinds of things that lead to divorce ... and the aftermath, the blended families," she says.
Stanley also highlights the significant changes in the distribution of wealth, education opportunities, access to technology, living conditions, and employment opportunities.
There has also been the "rise of the individual and the downgrading of children", she says. There is less community support, less social capital. "Government services and non-government organisations are struggling to handle the numbers of children who are in crisis. That is what I will be preaching this year - we have to put some emphasis on preventing these problems in our society."
You won't find many who disagree with Stanley. From pediatricians to mental health experts, the warnings are the same.
Professor Ian Hickie, chairman of the Melbourne-based national depression initiative beyondblue, says there has been great progress in the control of physical illnesses in children and adolescents. "Now the big problem is mental health, which has been a neglected area for so long," Hickie says.
While rates of depression in old people have fallen because of improving physical health, anxiety and depression, suicide rates and alcohol and drug use have increased unchecked in children and adolescents, he says. "We need to focus on the more complex issues around social networks ... disconnected communities and more pressures on parenting. For children, the focus on educational success gets out of proportion with other issues."
Both Stanley and Hickie push the concept of early intervention - not just for children with mental illnesses, but for those on the edge of the criminal justice system.
"Kids in trouble ... are the worst served by our current mental health system," Hickie says.
For Michael Sawyer, professor of child and adolescent psychiatry at the University of Adelaide, the high prevalence of mental illness among young people must be tackled in the same way infectious diseases were 100 years ago.
"It involves interventions on a number of levels - with infectious diseases that meant looking at housing, sanitation, education ... and when you improved those things, you got infectious diseases under control.
"Mental health problems require a similar range of interventions," he says.
Sawyer warns that children with significant health problems, such as diabetes or asthma, are also at increased risk of developing mental illnesses. "Whatever the case, it is a prevalent condition that causes a substantial amount of distress, which is why it is so important to improve our prevention programs," he says.
Last year Stanley took on the role of chief executive officer at the newly-formed Australian Research Alliance for Children and Youth. There are high hopes for the alliance, which will focus on all health problems, from brain development, early childhood issues and education, to crime prevention and early intervention at a child's first contact with criminal justice system. "If you want a future, if you want to compete as a knowledge-based nation ... you cannot have one in five kids going off the rails, because that is one in five future parents going off the rails."
There is a confidence among her colleagues that the alliance, with Stanley at the helm, will succeed. Science and medicine are in her blood. Her husband, Professor Geoffrey Shellam, holds the microbiology chair her father Neville created at the University of Western Australia. Her brother is a top scientist in the US, her sister is an associate professor in veterinary sciences, also in the US.
Born in Sydney in 1946, Stanley moved to Perth with her family in 1956 and later studied medicine at the University of Western Australia. But it was the field of epidemiology that grabbed her - lifting her from the depression that set in after seeing little improvement in basic health standards in the two years she worked in Aboriginal health.
Along with a colleague, Stanley first showed that a maternal diet rich in folic acid can prevent spina bifida in babies. She also found that cerebral palsy is due not so much to birth trauma, as previously thought, as to other factors such as infections or blood incompatibilities. "[Epidemiology] taught me how to use research to improve social justice - that is a pretty powerful thing," she says.
It was one of the institute's first studies on childhood mental health in 1992 that next caught her attention. Eighteen per cent of males and 15 per cent of females reported experiencing mental illness. But only 3 per cent of those teenagers were getting access to assistance. "Are we going to keep on blaming schools for the problems in our children, or are we as a society ... going to take responsibility for preventing these illnesses?" Stanley says."We want to say this is a priority for the nation, that it is more important than anything else."
Twelve months as Australian of the Year should give her the best chance she's had so far to shine the light on one of health's most neglected areas.
A project that goes beyond the personal
Secondary schools are obvious sites for health promotion, holding a captive audience of adolescents who can experience traumas arising from activities such as substance abuse and risky sexual behaviour as they pass through the grades.
One Melbourne-based program has tried to move health promotion in schools beyond the personal to create more supportive environments and strengthen community action and advocacy.
The Gatehouse Project, run in 26 Victorian schools, has achieved remarkable results, says Professor George Patton, from the Centre for Adolescent Health at the Royal Children's Hospital in Melbourne.
"The reductions in tobacco use, binge drinking, socially disruptive behaviour and early initiation of sexual intercourse were of the order of 20 per cent to 30 per cent," Patton says. "It was a new approach - it wasn't health, it wasn't education, it was a combination. The new problems that are facing children and youth are complex in their origin; they will demand communities of all kinds pulling together - schools, families and local neighbourhoods."
The aim of the project was to work out how schools could better respond to and prevent mental illnesses, Patton says. Students were surveyed about their beliefs around security, communication and participation, looking at issues such as bullying, social support and attitudes to school. They were also asked about tobacco, alcohol and other drugs, theft, violence and sex, depression and self-harm.
It was then up to the schools to review the survey reports and introduce strategies to meet their needs.
An adolescent health team was established in each school, made up of school staff and representatives from external health agencies.
Among the strategies implemented were guidelines for the prevention of bullying, mentoring and peer-support programs, Patton says.
"It represents a promising new direction for school health promotion work," he says.
Copyright © 2003. The Sydney Morning Herald.