Analysis Contemporary Policy Issues: Mental Health - Research Paper Example

 Part II: Analysis Contemporary Policy Issues: Mental Health Introduction Mental Health Services in Australia have developed from certain different perspectives, and the current attempts for enhancing access to services and stress on preventative mental health through increasing participation of consumers in the care process are indicated by the current mental health policy directives. The COAG action plan lists the relevant policies and agreed outcomes (Council of Australian Governments National Action Plan for Mental Health 2006-2011, 2008). Two such policies are "promotion, prevention, and early intervention" in order to reduce the severity and prevalence of mental illness in Australia and "increasing workforce capacity" which would improve access of people with developing or established mental illness to appropriate mental health services in the appropriate time in order to facilitate early intervention so in relevant cases prevention can be implemented. In this article, these two policies will be analysed and reviewed critically in order to develop a deeper understanding about the implications of these policies and their effects in order to create an evidence base drawing upon contemporary mental health literature, so it can guide practice. It appears that there is a need for critical review of these policies, since some authors have criticized that these mental health policies are futuristic. The Commonwealth of Australia (2004) contends that there are inconsistencies between policies and reality, and despite the policy directives of an approach towards preventive mental health, there is an observed ignorance towards the consumer involvement in the care processes with emphasis on medicalized approach towards mental health delivery. The policy of promotion, prevention, and early intervention which are only possible through participation, collaboration, and community based care. Council of Australian Governments National Action Plan for Mental Health 2006-2011 (2008) recommended a community-based, recovery-focused mental health system which will have ingrained elements of mental health promotion, prevention of mental illnesses, and services directed towards early intervention. This points to the need for reexamination of the actions, since some authors expressed the need for expansion of preventive and early interventional cares, for example, in suicide attempts in regional areas, where responses are poor with inappropriate hospital-based acute care even with potentially harmful premature discharge from the hospitals. This concept of promotion, prevention, and early intervention as a policy actually springs from the idea that people at risk will be actively involved in the care delivery system through collaboration and partnership. If the goal is to reduce prevalence and severity of mental ill health in the Australian population, the promotion of mental health should be the prime intent, and the approach should be preventive. This is a drift from the medical approach from mental health, and biological causes of mental illnesses are, in this model, paid no extra attention as it was in the earlier times (Herman and Jané-Llopis, 2005). It has been suggested that there is an element of social inclusion which automatically reduces stigmatization, where mentally ill or people who are exposed to predisposing environment can be reached within the community to prevent or lessen the severity of the disease through their participation in care delivery. This indicates a need for understanding the contexts of the people who are already affected or are going to be affected very soon. The youth mental health is such a jurisdiction, where preventive approach and mental health promotion can be very effective, especially when substance abuse is considered. In this jurisdiction, promotion, prevention, and early intervention may play very significant roles in reducing the mental health burden considerably (Patton et al., 2000). Donovan et al. (2007) indicated that people's perception about mental health indicates three parameters. These are having social interactions where people can express their problems, keeping mind active, and ability to control one's own life. People although have negative connotations about mental illness, they think mental illness is maximally contributed to by three factors, life crises and consequent mental traumas, absence of a support network or friends with whom sharing of thoughts can be done, and drug or alcohol abuse. This study indicated that communication in mental health promotion interventions are viewed as relevant and necessary as a policy implementation (Donovan et al. 2007). Robinson and Pennebaker (2002) quoted data from Commonwealth Department of Human Services and Health (1998) to indicate that mental health problems affect 10 to 15% of the young Australians in any given year, but only 38% of the adult individuals get some mental health care, leading to disabilities related to mental health with considerable morbidity, but this defeats the policy of prevention, promotion, and early intervention, since the extent of mental health disabilities are high. Indicating a drift from the treatment services, therefore, a strategy for promotion and prevention can be a strategic step towards ensuring mental wellbeing of the population, which would eventually ameliorate a large burden of mental health disorders (Sawyer and Kosky, 1996). Substance abuse is a jurisdiction where adverse consequences of substance abuse including alcohol may be the cause of a series of social problems, harmful injury, illnesses including mental ill health, and even death, and these effects not only concern the user, but the wider community is also not spared. As the policy indicates, the Government of Australia is currently beginning to invest profusely in prevention policies. Although regulation of access to substances is a recognized measure through legislations on drug control, as McCain and Mustard (1999) indicates, the current trend is on investing on early years of life, so the youth can prevent adverse experiences in early life leading to prevention of, as stated by Karoly et al. (1998), costly mental health problems as they are grown up. Evidence indicates that steps to prevent substance abuse in the early years of life are important and challenging due to the fact that an abuse behaviour picked up early on persists throughout adulthood, and consequently these need interventions in order to prevent them and resultant serious illnesses and premature deaths. The Commonwealth Department of Health and Aged Care (2000) define mental health promotion to be actions to ensure maximization of mental health among individuals and populations. However, researchers think that there is some vagueness regarding accurate delineation of these actions and timing. For example, when a mental illness is well established in the individual, although promotion may happen, it may not be able to prevent the disorder any more. Mrazek and Haggerty (1994), therefore, offered a workable definition of mental health promotion which states preventive interventions implemented before initial onset of the disorder leading to prevention of its occurrence (Mrazek and Haggerty 1994). Quite clearly this would need far intense involvement of different agencies in order to anticipate a possible deviation from normal in the near future, and interventions are not medical, rather interventions are directed towards controlling the scenario and conditions which predispose to a future mental ill health. This definition attempts to change the traditional concepts about mental illnesses. Many mental conditions are treatable, and many of them are preventable with early interventions directed to specific social situations. Herrman (2001) contends that encouragement to early entry into care has the immense possibility of improving outcomes, which in turn would be very inclusive in lessening stigma and discrimination. There has been evidence from primary health care that preventive interventions directed towards groups which are at high risk of specific mental disorders can prevent mental illnesses. However, early intervention and prevention are steps in two different dimensions of mental health care. It has been indicated that prevention needs better understanding of the nature of mental illness and mental health, and it can only be accomplished through changing policies, priorities, and practices in different areas other than mental health alone (Toumbourou et al., 2007). Rowling (2007) indicates this to be a key mental health reform agenda in Australia. Taking the example of school mental health promotion, Rowling demonstrates that mental health promotion programmes in schools created supportive environments in order to enhance mental health in Australian secondary school communities. The success of this programme indicated that mental health as a positive concept is a valid conceptualization despite professional difference of opinion and difficulties in implementation from the political and practical points of views within nationally funded projects (Rowling 2007). The implication of the relevant mental health policy of promotion and prevention is a paradigm shift from the disease oriented models of mental healthcare, which focus on decreasing risk and increasing protection from disease. On the contrary, the mental health promotion approach looks for a different outcome, and the practice may not essentially need mental health physicians. There is indeed some conceptual differences between mental illness prevention and mental health promotion, but practically, many actions actually overlap between these areas (Barry et al., 2005). Jané-Llopis and Barry (2005) indicated although mental health professionals need to be actively involved, actually mental health promotion involves the roles played by a wide range of relevant sectors. Such an wide array of functions can be accomplished through mobilisation of different aspects of the society, and all are determinants of a sound mental health. These are social environment, social welfare, employment and labor, transport, criminal justice system and law enforcement, housing, education, and healthcare systems (Jané-Llopis and Barry 2005). Friedli (2002) indicated that effective mental health promotion programmes and interventions emanate from a better understanding about the role played by these factors in mental well being of any individual. Unfortunately, although a comprehensive health promotion-public health approach is necessary still intersectoral strategies from the perspective of mental health is lacking (Friedli 2002). This indicates that if the policy needs to be effectively implemented, there must be provisions for promotional interventions within the service system, where mental health promotion and prevention must be articulated in the wider planning of the health services dedicated to mental health. Since this had not been uniformly implemented across Australia and studies have indicated gaps, it would be quite prudent to estimate that service environment is still not ripe enough to implement these into action. Moreover, it is quite possible there is lack in evidence whether these approaches are effective and the outcomes can be evaluated (Barry, 2003). Boyle et al. (2007) indicated mental health promotion in the communities is mainly activities in relation to promotion of mental wellbeing. Although these were executed by nonprofit organisations, this study delineated the key types of activities for mental health promotion, which are not mentioned in the national health policies. These are provision of support, provision of services, sharing of information, activities that promote mental wellbeing, and advocacy. It is important that policy implementation must have an in-built process of systemic evaluation of long-term outcomes. This study is particular important from the point of view that training and education of care delivery professionals emerged as a prominent need for implementation. It was noted that adverse psychosocial circumstances are the commonest environmental factors that predispose to the risk of mental ill health. Therefore, promotion and prevention activities should attempt to modify the psychosocial circumstances, but extensive practice is needed to cover all areas, and skilled and trained professionals can only ensure such a wider coverage. Hawkins et al. (1997) stressed the importance of community based interventions as the central mode of activity for mental health promotional activities. The community activities are conducted in schools, places of work, youth centres, or community centres. These activities are based on the premise that people likely to be affected with the problem can have an opportunity to participate more actively in the processes of change, and thus the community members may be actively engaged to address positive mental health. The school setting is the perfect place to influence young people, where they can be helped to cope easily with changes, and this can be a key protective factor for positive mental health promotion and related behaviours. Anteghini et al. (2001) indicated that this community perspective in policy implementation needs suitable models of action and appropriate strategies in order to achieve adequate outcomes, and these are possible through extensive participation of all stakeholders, namely, citizens, target groups, other community groups, mental health professionals, governmental agencies, and nongovernmental organisations through partnership and collaborative work and intersectoral interactions. The current state of affairs indicate that actions are far less than optimal, and within a 12-month period 20% of the Australians are affected by mental health problems with young adults being the largest victims. Recent data indicates the highest age group affected to be 18 to 24 years with at least one mental disorder in a 12-month period (ABS 2008). This indicates the failure of earlier policy of treatment based medical interventions and also indicates the effects of personal, social, and financial jeopardies to be effective in causing these problems. The current policy understands the urgent need for earlier interventions through actions oriented to promotion and prevention of mental illnesses through clear actions plans for progressing activities. The service environment naturally is the prime area of focus, but unfortunately, rather than planning it appears that services developed in an ad hoc manner, so the policy makers now are thinking about examining the readiness and capacity for provisions of these services. Rather than a treatment focused service, the need of the hour is provisions for population focused services. It is expected that the service which had long been oriented to biomedical model of mental illness will have difficulty in reorienting to mental health promotion as the principle strategy where the main problem would be access and deficiency of capacity to handle the actions related to health promotion (Jané-Llopis et al., 2005). Taking the case of the young substance abusers, the focus would now be prevention of drug abuse in the young at the very outset by through mental health promotion. The biomedical model of drug abuse would look towards the harms associated with established drug use, whereas effective prevention of substance abuse would demand effective targeting of the predisposing reasons for taking recourse to such behaviours. Obviously the reasons why a young individual starts to use a substance are in the families, communities, societies, peers, support groups, social circles, and availability of substances of abuse, which need to be intervened proactively if the policy desires to prevent one (Lenton, 1996). Before the desire to abuse a substance becomes a pattern of substance abuse promotion of positive mental health should take priority to prevent it. This needs trained and skilled individuals in the community to intervene in the setting (Collins and Lapsley, 2002). Unfortunately, the action plan although admits to this need has no provision for proactive intervention in these groups of high-risk young individuals due to sheer lack of manpower. While the biomedical treatment model can effectively manage situations when a person with substance abuse history seeks help, it cannot guarantee a recovery or relapse or harms out of such behaviours. The very possibility that mental illness include substance abuse may experience recovery through appropriate interventions changes the premise immensely since people who once abused substances may lead a normal and socially effective life in future points at the loophole in the biomedical model which can foster exclusion and stigmatisation. It is here, the community mental health promotion model may seek to intervene effectively changing the outcomes drastically. With an example, this would become clearer (Chikritzhs et al., 2003). It is a well known fact that the young individuals who abuse substances also have higher rates of double mental illnesses such as associated depression, schizophrenia, and personality disorders. The suicide rates are also high in these individuals. It is debatable which one is the first to occur, a mental illness or abuse behaviour. The propensity of dual disease in substance abuser makes the case of prevention of abuse stronger through promotional approaches. If mental health promotional and preventive approaches through community intervention work in individuals with history of or current substance abuse, logically, it would also be the case that substance abuse can be prevented at the outset through the same approaches. Taking the case of suicide attempts in the young individuals, many seek mental health support of treatment after a failed attempt at suicide, and indeed, suicidal ideation and intent are important diagnostic criteria for many disease models of mental illnesses (National Crime Prevention, Attorney-General’s Department, 1999). Delay in help to a person who attempted suicide may lead to death of the individual, and many data in the Australian context have indicated high rates of suicide. It appears given the nexus of psychosocial situations promoting mental illness leading to lack of positive mental health driving a desire to abuse substance leading to dual disorder leading to suicidal intent can best be targeted through promotional interventions towards psychosocial modifications and changes in an intersectoral and collaborative fashion where the desire to abuse a substance in a young population can be prevented, which would automatically reduce the rates of suicidal intents and incidences. This needs at least three parameters, one intent to promote positive mental health, collaborations between sectors and community, and skilled people who can reach the people at risk. This indicates that the two policy intents in this discourse to be interrelated, relevant, and the inevitability of the fact that without one the other cannot happen (Spooner et al., 2001). Loxley et al. (2004) in their analysis of prevalent patterns of substance related harms indicated the youth related priority areas, which are short-term intoxicating heavy use of alcohol, administration of illicit substances by injection, and risky patterns of use of prescription drugs by early adolescents. Within the population based approaches, one promotional activity would be efforts to prevent young individuals from experimenting with potentially harmful substances, but as it appears, this is just one part of the promotional approach which need to be acted upon within the community and population. However, adequate knowledge about these patterns of behaviours would naturally indicate that there are opportunities for interventions within social, legal, and physical environments in which substance abuse occurs, and this would involve the whole community. The preventive approach would need to target not the substance abuse problem per se, but would focus on desired changes in the shared developmental and social risks and protective factors which might influence the psychosocial adjustments of the young individuals. Williams et al. (2000) indicated that the preventive and promotional approaches should target the quality of engagement at early stages of development and their interactions with families, peers, schools, and other factors inherent in the wider community. Research has demonstrated the common link between substance abuse problems and these other factors which are very common in young adulthood, such as, mood disorders, maladjustment, truancy, unprotected risky sexual behaviours, and delinquency, and these are noted ultimately to culminate into problems with substance abuse. Research merely hints at associations, not causal relationships, but these links at causality may serve as a basis for developing interventions to prevent later problems. This also means if prevention is the agenda, there is a need for comprehensive programmes within the broader perspectives of all age groups within the community who can participate in ameliorating the shared risk factors in order to effect a positive change within the diverse range of problems in the early years, and in this way, the comprehensive preventive and promotional agenda may intervene with the context-specific problems which may ultimately be amenable to a wide variety of preventive measures (Topp and McKetin, 2003). This needs constant surveillance, knowledge, skills, and participation. Quite rightly the question of capacity building becomes relevant. Capacity building has been defined by Hawe et al. (1999) to be development of sustainable skills. resources, organizational structures, and commitment to improvement of health and other related sectors in order to multiple and sustain the gains. Obviously, the promotion and prevention policy in mental health would demand orientation of the mental health services so they can assume greater responsibilities in improving the mental health of the communities. Gray and Casey (1995) indicated this to be a process of systemic change, and the NSW Health (2001) identified the need for capacity building in the areas of leadership and partnership, allocation of resources, development of service infrastructures, and development of workforce. The other policy that is dealt in this assignment is "increasing work force capacity." This means in order to implement the first policy, “increase in the workforce capacity” is needed urgently. As expected, this would allow access of people to the services, where increased proportion of people with established mental disorder or with emerging mental illness would be able to access the appropriate mental health care and other related services available in the community, and early intervention will be feasible. While the action of promotion, prevention, and early intervention is a broad action plan, the main functions involved would raise the awareness of the community, focus on young individuals to help build their resilience and other coping skills, this needs improvement of capacity building so these conditions or emerging conditions are recognized early and referred to appropriate services early. Building skilled manpower in service providers is an important parameter of that which would also help improvement of services which are armed with ability to respond better to early stages of developing mental illnesses, specially focused in children and young people (Lochman, 2001). Knowledge appears to be the most significant tool to achieve these, which means knowledge about onset of mental illnesses and actions necessary to prevent them would result from researches, where investment is necessary. Therefore, a process has already been initiated to develop the workforce in response to the identified priorities and gap in implementation. This would ensure that people within this system would contribute to community goals. However, this also needs development of the services in order to effect these changes. This would refer to the processes, structures, procedures, systems, and practices and its necessary changes aligned to the policy. To be effective, there is a need also to manage the changes necessary effectively. Reports indicate higher resource allocation in these areas, which indicate allocation of both financial and human resources. This is as indicated by Deeble (1999) an economic process directly related to information, administrative and physical resources, and workforce development. Gillies (1998) indicated that to be effective partnership between agencies and communities is a very critical element of these to be effective. Conclusion As indicated by these policies, in the Australian context, preventive approaches through mental health promotion at the level of the community can be very effective in preventing mental illnesses in risk or target groups, which can be an avenue of promoting positive mental health. This is a shift towards whole community approach from the traditional treatment approach to mental illnesses. While treatment of established mental illnesses cannot be ignored, these are ineffective in activities to prevent mental illnesses and to promote mental health. One essential component of such activities is ability to identify psychosocial determinants of emerging mental illness through identification of early warning signs within the community. While this states the need for developing a skilled and large workforce and funds targeted to that, the need for research to suggest programmes and their evaluation for effectiveness cannot be ruled out. Although the policy imperatives are directed to mental health services, there is a need for change in perspectives in many other sectors in social and political lives of the consumers, all of which would need to work in a collaborative and intersectoral manner to implement these policies. It is also important to ensure collaboration with the communities and consumers to assess their needs from their contexts and manage the necessary changes in the existing mental healthcare delivery systems, financial and human resources so ultimately the structures, systems, practices, and procedures align to the purpose, objectives, values, and roles efficiently. A drift of services from the specialist mental health sector is indicated by these policies, and community and primary care approach must be practiced by all sectors. Some such programmes are resilience and coping development programmes in the schools, parenting support programmes in the communities, suicide prevention programmes, but an increase in access through more skilled human resources are urgently needed to that end. Although some programmes such as supporting nongovernmental organizations and the private sectors to provide such services are in vogue for provision of quality services to people in need, services in the rural and aboriginal areas are still lacking, and a drastic improvement can be effected through utilisation of primary care with attempts towards development of new and expanded roles within the mental healthcare workforce within the government service and within the private and nonprofit nongovernment organisations, which would include a skill mix or professionals, not necessarily only psychiatrists and nurses, but including other allied health providers, social workers, occupational and family therapists, counselors, general practitioners, and Aboriginal and Torres Strait Islander health workers, to totally comply with the policy needs to satisfy capacity building in terms of distribution, supply, and skills. References ABS (2008). National survey of mental health and wellbeing: summary of results, Australia, 2007. ABS cat. no. 4326.0. Canberra: ABS. Anteghini, M., Fonseca, H., Ireland, M., & Blum, R.W., (2001). Health risk behaviors and associated risk and protective factors among Brazilian Adolescents in Santos, Brazil. Journal of Adolescent Health, 28(4), 295-302. Barry, MM., (2003). Designing an evaluation framework for community mental health promotion. Journal of Mental Health Promotion, 2(4), 26-36. Barry, M., Domitrovich, C., and Lara, MA., (2005). The implementation of mental health promotion programmes. Promotion & Education, Suppl. 2, 30-36. Boyle, FM., Donald, M., Dean, JH., Conrad, S., and Mutch, AJ., (2007). Mental health promotion and non-profit health organisations. Health Soc Care Community; 15(6): 553-60. Chikritzhs, T., Catalano, P., Stockwell, TR., Donath, S., Ngo, HT., Young, DJ. and Matthews, S., (2003) Australian Alcohol Indicators, 1990–2001: Patterns of Alcohol Use and Related Harms for Australian States and Territories. Perth,Western Australia: National Drug Research Institute and Turning Point Alcohol and Drug Centre Inc. National Drug Research Institute. Collins, D. and Lapsley, H., (2002). Counting the Cost: Estimates of the Social Costs of Drug Abuse in Australia in 1998–9. Monograph 49. Canberra: Australian Government Department of Health and Ageing. Council of Australian Governments National Action Plan for Mental Health 2006-2011: COAG National Action Plan on Mental Health, (2008). Progress Report 2006-07, p. 1-26. Commonwealth Department of Health and Aged Care, (1998). The Mental Health Promotion and Prevention National Action Plan. Commonwealth Department of Health and Aged Care, Canberra Commonwealth Department of Health and Aged Care, (2000). National Action Plan for Promotion, Prevention and Early Intervention for Mental Health Canberra 2000 sets out the outcomes, rationale, evidence base, sectors and settings for activity in mental health PPEI http://www.health.gov.au/hsdd/mentalhe/mhinfo/ppei/nap2000.htm Commonwealth of Australia (2004) The Framework for the Implementation of the National Mental Health Plan 2003-2008 in Multicultural Communities Deeble, J., (1999). Resource Allocation in Public Health: An Economic Approach. National Public Health Partnership, Melbourne. Donovan, RJ., Henley, N., Jalleh, G., Silburn, SR., Zubrick, SR., and Williams, A., (2007) People's beliefs about factors contributing to mental health: implications for mental health promotion. Health Promot J Austr; 18(1): 50-6. Friedli, L., (2002). Éditorial. Journal of Mental Health Promotion, 1(2). Gillies, P., (1998). Effectiveness of Alliances and Partnerships for Health Promotion. Health Promotion International. 13, 99-120. Gray, E. and Casey, L., (1995). Building Capacity for Health Gains in Two Australian Settings. International Health Promoting Hospital Conference, Linkoping, Sweden, 1995. Hawe, P., Degeling, D., and Hall, J., (1990). Evaluating Health Promotion: A Health Worker's Guide. MacLennan and Petty, Sydney. Hawkins, D., Arthur, M., & Olson, J. (1997). Chapter 34: Community interventions to reduce risks and enhance protection against antisocial behaviour. In D.W. Stoff, J. Breiling & J.D. Masers (Eds.), Handbook of antisocial behaviour (pp.365-374). NIMH/John Wiley. Herrman, H., (2001). The need for mental health promotion. Aust N Z J Psychiatry; 35(6): 709-15. Herman, H. and Jané-Llopis, E, (2005). Mental health promotion in public health Promotion & Education; 12: 42 - 47. Jané-Llopis, E. and Barry, MM., (2005). What makes mental health promotion effective? Promotion & Education; 12; 47-56. Jané-Llopis, E., Barry, M., Hosman, C., and Patel, V., (2005). Mental health promotion works: a review Promotion & Education; 12: 9 - 25. Karoly, LA., Greenwood, PW., Everingham, SS., Hoube, J., Kilburn, MR., Sanders, M., et al., (1998). Investing in Our Children: WhatWe Know and Don’t Know About the Costs and Benefits of Early Childhood Interventions. Santa Monica: RAND Corporation. Lenton, S., (1996). The essence of prevention. In C.Wilkinson and B. Saunders (eds), Perspectives on Addiction: Making Sense of the Issues. Perth: William Montgomery, pp. 73–80. Lochman, JE., (2001). Issues in prevention with schoolaged children: Ongoing intervention refinement, developmental theory, prediction and moderation, and implementation and dissemination. Prevention and Treatment, 4, np. Loxley, W., Toumbourou, J., Stockwell, T.R., Haines, B., Scott, K., Godfrey, C., Waters, E. and Patton, G., (2004). The Prevention of Substance Use, Risk and Harm in Australia: A Review of the Evidence. Canberra: Australian Government Department of Health and Ageing. McCain, MN. and Mustard, JF., (1999). Early Years Report: Reversing the Real Brain Drain. Final Report. Ontario: The Canadian Institute for Advanced Research. Mrazek, P.J., & Haggerty, R.J. (Eds.). (1994). Reducing risks of mental disorder: Frontiers for preventive intervention research (p45-47). Washington: National Academy Press. National Crime Prevention, Attorney-General’s Department, (1999). Pathways to Prevention: Developmental and Early Intervention Approaches to Crime in Australia. Full Report. Canberra: National Crime Prevention, Attorney-General’s Department. NSW Health (2001). A Framework for Building Capacity to Improve Health. NSW Health Department, Gladesville, New South Wales Robinson, S. and Pennebaker, D., (2002). Mental health promotion and illness prevention in Western Australia: a study of service capacity. Health Promot. Int.; 17: 263 - 272. Patton, GC., Glover, S., Bond, L., Butler, H., Godfrey, C., Di Pietro, G., and Bowes, G., (2000). The Gatehouse Project: a systematic approach to mental health promotion in secondary schools. Aust N Z J Psychiatry; 34(4): 586-93. Rowling, L., (2007). School mental health promotion: MindMatters as an example of mental health reform. Health Promot J Austr; 18(3): 229-35. Sawyer, MG. and Kosky, RJ., (1996). Mental health promotion for young people: a proposal for a tripartite approach. J Paediatr Child Health; 32(5): 368-70. Spooner, C., Hall,W. and Lynskey, M., (2001). Structural Determinants of Youth Drug Use. Canberra: Australian National Council on Drugs. Topp, L. and McKetin, R., (2003). Supporting evidence-based policy-making: a case study of the Illicit Drug Reporting System in Australia. In Bulletin on Narcotics Volume LV, Nos 1 and 2, 2003. The Practice of Drug Abuse Epidemiology. Vienna: United Nations Office on Drugs and Crime. Toumbourou, JW., Hemphill, SA., Tresidder, J., Humphreys, C., Edwards, J., and Murray, D., (2007). Mental health promotion and socio-economic disadvantage: lessons from substance abuse, violence and crime prevention and child health. Health Promot J Austr; 18(3): 184-90. Williams, B., Sanson, A., Toumbourou, J.W. and Smart, D., (2000). Patterns and Predictors of Teenagers’ Use of Licit and Illicit Substances in the Australian Temperament Project Cohort. Melbourne: University of Melbourne. Read More