Stathis Stephen L, Letters Paul, Doolan Ivan, Whittingham David
Child and Family Therapy Unit, Royal Children's Hospital, Herston, Australia.
Drug Alcohol Rev. 2006 Mar;25(2):149-55. doi: 10.1080/09595230500537613.
This article describes the frequency of co-morbid substance use and mental health problems of young people within the youth justice system and demonstrates that mental health and drug and alcohol services can be integrated and work effectively. The establishment of an integrated Mental Health Alcohol Tobacco and Other Drugs Service (MHATODS) to juveniles in detention represents a shift away from the traditional paradigm of separate services frequently found throughout Australia. The development of referral procedures and adolescent-focused treatment programmes that are tailored to the specific needs of this disadvantaged population are discussed. A wide-ranging literature review illustrates the consequences of the high prevalence of co-morbid substance use and mental health problems in juveniles within the youth justice system. A retrospective and descriptive account is given of the expansion of the MHATODS, including the recruitment of an Indigenous health worker, the incorporation of an automatic referral process for young people with substance use problems and the development of a brief four-session drug and alcohol counselling programme and a group relapse prevention programme. The proportion of Indigenous clients referred to MHATODS is now equitable to referrals of non-Indigenous youth. The introduction of an automatic voluntary referral process resulted in an increase in referrals for drug and alcohol assessment and counselling from 17% to 64% of total referrals. Of those young people commencing the drug and alcohol programme, 32% completed all sessions. While young people reportedly enjoyed the group programme, feedback from participants indicated that they felt vulnerable in a group setting. MHATODS recognises the limitations of the prevailing paradigm of separate service delivery for mental health and drug and alcohol treatment, and has developed an integrated treatment service for juveniles in detention. The service has expanded its referral base for substance use problems by employing an Indigenous health worker, and initiating an automatic referral process for young people admitted into detention who have a history of significant substance use. Early evidence indicates increased utilisation of drug and alcohol services by young people in detention.
本文描述了青少年司法系统中年轻人共病物质使用和心理健康问题的发生率，并表明心理健康与毒品和酒精服务可以整合且有效运作。为被拘留青少年建立综合心理健康、酒精、烟草及其他毒品服务机构（MHATODS），代表着与澳大利亚各地常见的传统单独服务模式的转变。文中讨论了针对这一弱势群体的特定需求制定的转诊程序和以青少年为重点的治疗方案。广泛的文献综述阐述了青少年司法系统中青少年共病物质使用和心理健康问题高发的后果。对MHATODS的扩展进行了回顾性和描述性说明，包括招聘一名原住民健康工作者、为有物质使用问题的年轻人纳入自动转诊程序，以及制定一个简短的四节毒品和酒精咨询方案及一个团体复发预防方案。现在，转介到MHATODS的原住民客户比例与非原住民青少年的转介比例相当。引入自动自愿转诊程序使毒品和酒精评估及咨询的转介量从总转介量的17%增至64%。在开始毒品和酒精项目的年轻人中，32%完成了所有课程。虽然据报告年轻人喜欢团体项目，但参与者的反馈表明他们在团体环境中感到脆弱。MHATODS认识到心理健康与毒品和酒精治疗的现行单独服务模式的局限性，并为被拘留青少年开发了一种综合治疗服务。该服务机构通过雇佣一名原住民健康工作者，并为有大量物质使用史的被拘留年轻人启动自动转诊程序，扩大了其在物质使用问题方面的转诊基础。早期证据表明，被拘留青少年对毒品和酒精服务的利用率有所提高。
