Management of mental health problems in young people in primary care
Early intervention has been identified as a key priority to help improve health outcomes. For youth with mental health
problems early intervention may potentially prevent these problems from continuing into adulthood.19 Psychological
problems, such as behaviour and conduct issues, significant truancy and excessive anxiety, may be the precursors to
adult mental health disorders.
In any young person presenting with mental health problems, an assessment of suicide risk should always form part
of the initial consultation and risk should be continually monitored.
Structured clinical assessment tools
A structured clinical assessment tool can be used to help gain a more complete understanding of the patient’s
wellbeing. These tools are intended as a guide for questioning. Other factors, such as the specific presenting problem
and clinical judgement, may alter the flow of questions within a consultation.
The following tools could be used:
- Home: general behaviour, conduct, manageability
- Education: behaviour, progress
- Activities: attention span, anxiety, ability to finish tasks, friendship
- Relationships: with peers, parents, whānau, recent changes, bullying
- Temper: mood
- Size: weight change, appetite
- Home: existing and new relationships, communication
- Education/Employment: school grades, work hours, responsibilities
- Eating: body image, weight changes, dieting, exercise
- Activities: with peers, whānau
- Drugs: tobacco, alcohol, other drugs, use by self, whānau, friends
- Sexuality: sexual identity, relationships, coercion, contraception, pregnancy, sexually transmitted
- Suicide and depression: sadness, boredom, sleep patterns, loss of enjoyment
- Safety: injury, violence, rape, bullying, weapons
A strengths-based approach to management
Most young people with mild to moderate mental health problems can be managed in primary care with
advice, active support and monitoring. Referral to other services may be required for severe problems and for some
conditions, e.g. a suspected psychotic disorder. Referral may also be required to access specialised therapies, e.g.
cognitive behavioural therapy or psychotherapy.
The overall aim of management is to promote a positive attitude and encourage development of the skills required
to help overcome issues affecting the person. Using a strengths-based approach helps to identify and develop these
strengths and positive attributes.
A strengths-based approach for mental health problems
A strengths-based approach helps to build confidence, motivation and self esteem. Key components include:
- Identification and development of skills and strengths – these may not always be obvious or recognised
by the young person or the people around them
- Building of motivation to deal with problems
- Increasing social interaction and enhancing relationships. Encourage social interactions especially with whānau,
friends and school or work contacts.
Encourage the young person to adopt coping strategies and to take an active role in their management, as this
may be empowering and a significant influence in promoting recovery.15
Listening to and appreciating the unique perspective of a young person may help them feel valued and appreciated.15 Help
the young person to think of a trusted adult that they can talk to. This may not necessarily be a parent, particularly
if the parental relationship is the cause of any distress. Support may come from someone else in the whānau such
as a grandparent, uncle or aunt. In some cases the trusted adult may be an outreach worker, practice nurse or GP. Ensure
the patient knows how to access urgent help if required.
Offer self management advice including guidance on exercise, sleep hygiene, stress management and misuse of alcohol
and other substances. Provide educational information for the young person and their whānau, including web-based
resources. Ensure there is a plan for follow-up and ongoing monitoring of suicidality. Consider referral to support
services such as counselling, group therapy and other outreach services. Check if follow-up is in place for young people,
who have been discharged from secondary care following admission for self-harm or mental health problems.
Medication in young people with mental health problems
Some young people with moderate to severe mental health problems, particularly depression, may require
medication. However, it is recommended that GPs only prescribe antidepressants for young people in consultation with
a psychiatrist or paediatrician. Fluoxetine may be used for major depression in young people, but requires careful
monitoring to detect any worsening of symptoms, suicidality or changes in behaviour.20
For further information see BPJ
Special Edition (Feb, 2010), “Depression in Young People” and the bestpractice Decision Support Depression