Jawun Research Centre, School of Health, Medical and Applied Science, Central Queensland University, Cairns, QLD 4870, Australia.
Gurriny Yealamucka Health Service, Yarrabah, QLD 4871, Australia.
Int J Environ Res Public Health. 2022 Dec 26;20(1):375. doi: 10.3390/ijerph20010375.
Concerns about the complexity, fragmentation and inefficiency of Australia's current youth mental health service systems have led policy makers to seek improvements through a shift to community-based solutions. However, there is little evidence of how communities can make this shift. This paper examines the efforts of one Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) community-Yarrabah in north Queensland-to develop strategies for mental health and wellbeing service system improvements for school-aged youth (5-18 years). The research was co-designed with Yarrabah's community-controlled health service and explores the perceptions of Yarrabah youth and service providers. Iterative grounded theory methods were used to collect and analyse data from 32 youth aged 11-24 years and 24 service providers. Youth were reluctant to seek help, and did so only if they felt a sense of safety, trust, relationality and consistency with providers. Young people's four suggestions for improvement were access to (1) information and awareness about mental health; (2) youth facilities, spaces and activities; (3) safe and available points of contact; and (4) support for recovery from mental illness. Service providers highlighted an appetite for youth-guided community change and recommended five improvement strategies: (1) listening to youth, (2) linking with community members, (3) providing wellbeing promotion programs, (4) intervening early, and (5) advocating to address the determinants of youth mental health. Overall, both groups realised a disjunct between youth need and service provision, but a willingness to work together for systems change. This study demonstrates the importance of community-driven efforts that harness both youth and service providers' perspectives, and suggests a need for ongoing dialogue as the basis for co-designing and implementing improvements to wellbeing supports and mental health services for Indigenous youth.
对澳大利亚当前青少年心理健康服务系统的复杂性、碎片化和低效率的担忧，促使政策制定者寻求通过向基于社区的解决方案转变来加以改善。然而，几乎没有证据表明社区如何能够实现这一转变。本文考察了一个澳大利亚原住民和托雷斯海峡岛民社区——北昆士兰州的雅拉巴拉(Yarrabah)——为改善面向学龄青少年（5-18 岁）的心理健康和福利服务系统而制定战略的努力。这项研究是与雅拉巴拉社区控制的卫生服务机构共同设计的，探讨了雅拉巴拉青年和服务提供者的看法。采用迭代扎根理论方法，从 32 名 11-24 岁的青年和 24 名服务提供者那里收集和分析数据。青少年不愿寻求帮助，只有在他们感到安全、信任、关系和与提供者一致性的情况下才会寻求帮助。年轻人提出了四点改进建议：(1) 获得关于心理健康的信息和意识；(2) 为年轻人提供设施、空间和活动；(3) 建立安全和方便的联系点；(4) 为从精神疾病中康复提供支持。服务提供者强调了对以青年为导向的社区变革的兴趣，并提出了五项改进策略：(1) 倾听青年的意见；(2) 与社区成员建立联系；(3) 提供促进健康的方案；(4) 及早干预；(5) 倡导解决青年心理健康的决定因素。总的来说，两组人都意识到青年需求和服务提供之间存在脱节，但都愿意共同努力进行系统变革。这项研究表明，社区驱动的努力非常重要，这些努力利用了青年和服务提供者的观点，并建议需要进行持续对话，作为共同设计和实施改善土著青年福祉支持和心理健康服务的基础。
