Family/caregiver support and community activities
Regardless of the specific mental health problem or symptoms, all young people have some basic needs for their mental
- The need to feel loved
- The need to belong
- The need for hope and faith in the future
These three needs can be provided by family/whānau, and where families cannot provide them, other sources such
as schools, churches, sporting clubs or mentors may help. Without addressing these basic needs, mental health interventions
often make limited progress.
The individualism of western culture often leaves young people feeling isolated and unsupported. This influence can
be counteracted by encouraging the development of the wider family and its involvement in the lives of young people. For
Māori, elements of belonging such as pepeha, visiting their marae, understanding tikanga or walking their land can
Mentors can be effective in some circumstances, particularly when working with adolescents with more severe problems.
The availability of good mentor programmes (trained, supervised, regular and prolonged) is variable by region and demand
often exceeds the capacity of the volunteers.
Culturally based programmes (particularly in acculturated youth) have been shown to be effective, particularly in adolescents
with alcohol, drug and violence problems. These programmes are available through kaupapa Māori organisations.
Activities and exercise are useful for a range of symptoms but particularly those where the young person is feeling
low. It is important that the young person finds an activity that suits their abilities, which could range from going
for a walk with family or friends, to playing sport at an international level.
Positive youth development (assisting positive development in young people) is effective for individuals and groups.
Youth development interventions that are effective tend to be intensive, prolonged and involve multiple areas of a young
person’s life. Programmes are available in most communities and include, for example, groups focused on sports,
conservation, culture, outdoor education and work experience. Participating in the group involves learning new skills
and activities, being involved, socialising, having fun and taking risks within a safe environment.
Youth One Stop Shops are available in some regions, to allow young people to access the help they need on their own,
with staff who are skilled in talking to, listening to and understanding young people. Sometimes the best one stop shop
is at the high school (or alternative education), particularly if it has counsellors, nurses, general practitioners or
Cognitive behaviour therapy has been shown to be effective in a wide variety of situations. This teaches young people
the relationships between their feelings, thoughts and actions and how to change their emotions and behaviours for themselves.
Some general practices may offer these services or patients can be referred to specialist clinics.
“Talk therapies” can be effective and seem to rely more on the relationship with the therapist than the
actual therapy involved. This is widely available in the community.
Motivational interviewing is a specific type of talk therapy targeting problem behaviours. It is effective for changing
a range of unhelpful behaviours (that are associated with mental distress), from drug use to overeating. General Practitioners
can assist patients to find a therapist who specialises in this method, such as a drug and alcohol counsellor.
Family interventions such as family therapy can be effective when the focus is on family dysfunction rather than the
individual. This is offered by a number of organisations in the community.
Multi-systemic therapy and Functional Family Therapy have been shown to be effective in conduct disorder (persistent
bad behaviour). Both are intensive family based interventions.
In some circumstances, antidepressants may be considered for an adolescent with a mental health problem such as depression.
However, antidepressants such as serotonin re-uptake inhibitors (SSRIs) are not approved for use in people aged under
18 years, so are used “off-label”. If an antidepressant is used, fluoxetine is considered the best choice
for adolescents. It is important to maintain regular contact with the young person and to monitor for suicidal thoughts
or other negative behavioural changes, especially in the first few weeks following prescription of the antidepressant.
It is recommended that antidepressant treatment in a person aged less than 18 years should not be initiated in primary
care without consultation with a child and adolescent psychiatrist.
For further information see: “
Depression in young people ”, BPJ Special Edition (Feb, 2010).