Social justice is the key concern of the social work profession. In clinical settings, where the focus is frequently narrowed down to individuals and individual pathology, the role of social work lies in constantly widening the focus to explore the wider context. This study has been conducted with this role in mind. It is concerned with the impact of social disadvantage on the provision of contemporary mental health services to Australian children and young people.
There have been a number of studies in the American academic literature which indicate that socially disadvantaged children and young people have been seriously under-represented in clinical populations, in spite of the fact that they are the group most at risk of mental health difficulties. In addition there have been concerns expressed in the literature that this group of children and young people are doubly disadvantaged in obtaining appropriate treatment because of a higher propensity to dropout of therapy, especially in the early stages of treatment. These are disconcerting findings. This study sets out to explore the relevancy of these social justice concerns in the Australian context where the topic has been relatively un-researched and where the underlying structure of health service provision differs from that in the USA.
This study aims to do three things. Firstly, it aims to explore whether such discrimination exists in an Australian context by investigating the socio-demographic characteristics of an Australian child and youth mental health service population. Secondly, the study aims to explore the connection between dropout and dissatisfaction with service as a first step in designing interventions which mighto did not prevent dropout. The third aim of the study is to explore the association between social disadvantage and dropout by developing a predictive model of dropout which is able to distinguish between the characteristics of those who dropout early in therapy, those who dropout later, and those who do not drop out at all.
The study is based on the social and mental health characteristics of 303 children and young people admitted to a Brisbane Child and Youth Mental Health Service (CYMHS) community clinic during a twenty-one month period. The study utilised mailed questionnaire surveys and data collected from the clients' clinical records.
The findings of the study indicate that the clinical population is very socially disadvantaged, with low levels of income, employment and educational attainment. Families attending the clinic are essentially the people who have been identified by epidemiological studies as being most at risk of mental health difficulties. The study findings do not therefore support concerns expressed in the literature that socially disadvantaged children and young people are under-represented in the clinical population. A number of practice implications for working with disadvantaged clients are discussed. These include alternative forms of service delivery and the use of clinical interventions which are consistent with social justice concerns.
The dropout rate from therapy in the study is high at 42% with 20% dropping out within the first two sessions. These findings are in the middle of the range reported in the literature. A predictive model of dropout based on a range of socio-demographic, diagnostic and outcome measures proved unable to draw a distinction between the characteristics of those who dropped out from therapy and those who did not.
The study also considers the practical uses of the findings and discusses their potential value in the areas of quality assurance, future benchmarking, and in clarifying the likely social and clinical impact of several recent policy changes, both national and local. A number of areas for future research in this area of social justice are identified and their merits are discussed.