Health Services Research Unit

Mental health services

  • Mental health services and treatment

    At any point in time, one in seven Australian children will experience a mental health problem and half of all adult mental health problems are known to begin before the age of 14 years. However, many Australian children are missing out on mental health care. 

    Left untreated, these problems can persist into adolescence and into adulthood with adverse consequences including early school dropout, peer relationship issues, drug and alcohol offending, and lost productivity in the workforce. Early prevention and intervention is therefore essential.

    Potential causes of this include:

    • A lack of psychology services (rural, lower SES areas)
    • Out of pocket costs to families as a barrier to accessing care
    • Parent lack of awareness of mental health problems in their child
    • Waiting times to access care (public > private)
    • Prevailing customs and beliefs of clinician and/or patients.

    Current projects

    Detecting mental health problems in children with a chronic illness

    It is well recognised that children with a chronic illness are at greater risk of developing mental health problems such as anxiety or depression, than their healthy peers. However, many children with a chronic illness are not routinely asked about their mental health and wellbeing in health care settings. Working in partnership with RCH, we are conducting a project to determine if a single item asking parents about their child’s mental health and wellbeing can be incorporated into the admission process for children attending the day medical unit. We will also see how this single question compares with validated measures of child mental health and whether offering support and referrals to those children who are struggling with their mental health can make a difference to their mental health, over time. 

    Completed projects

    Mental health in the ED

    Using data from the Victorian Emergency Minimum Dataset, we examined seven year trends (2008/09-2014/15) in children’s presentations to EDs across Victoria. Specifically, we examined the number of children presenting for mental health versus physical health concerns; the characteristics of mental health presentations in comparison to physical health (e.g. length of stay, triage category, and admission patterns); and the range of mental health diagnoses resulting in ED presentations. We found that children’s presentations for mental health were growing more quickly than those for physical health problems, and that mental health presentations pose a relatively greater burden on ED resources than physical health presentations. Our findings were published in the Medical Journal of Australia with an accompanying editorial and podcast. Findings informed a successful MRFF Million Minds grant ($5 million) examining how to better manage and support children coming to EDs with mental health problems.


    • Hiscock H, Neely RJ, Lei S, Freed G. Paediatric mental and physical health presentations to emergency departments, Victoria, 2008-15. Medical Journal of Australia [Epub ahead of print] 2018 Apr 23. DOI: 10.5694/mja17.00434 PMID:29669495 

    Accompanying Editorials

    • Sawyer SM, Patton GC. Why are so many more adolescents presenting to our emergency departments with mental health problems? MJA 2018;208(8):339-40.

    • Mackie N. Kids forced into EDs for mental health a “national scandal”. MJA InSight 2018(15) 23 April 2018.

    Variation in service use in children with ADHD and sleep problems

    In this project, we sought to determine the types of services used by families for their child’s sleep problems; whether service use was associated with family geographical location or socioeconomic status; and to estimate the out-of-pocket costs associated with service use. We found that the majority of children with ADHD and sleep problems were not accessing help for their sleep problems. Help-seeking did not differ by geographical location or SES, although low income families were more likely to seek help than high income families. Lower SES families paid a similar amount per visit compared to high SES families however, the more disadvantaged group spent more overall across a three-month period due to a higher number of visits over the period.

    Why do children come to ED with anxiety and depression?

    Children across Victoria are increasingly presenting to emergency departments (EDs) with anxiety and depression. We interviewed families who presented to four EDs across Victoria with these problems. Families describe what brought them to the ED; what other services they tried before the ED; any barriers/enablers of accessing other services; whether there are any family factors that may have prevented them seeking help through another source; and what their ‘ideal’ would look like for the help they were seeking. Outcomes of this study have been published and will inform new models of care to reduce child mental health presentations to the ED and strengthen mental healthcare in the community.


    • Hiscock H, Connolly AS, Dunlop K, Perera P, O’Loughlin R, Brown SJ, Krieser DM, West A, Chapman P, Lawford R, Cheek JA. Parent perspectives on children and young people’s mental health services in Victoria – what’s wrong and how to fix it: A multi-site qualitative study. Journal of Paediatrics and Child Health 26 February 2020 doi:10.1111/jpc.14835
    • Hiscock H, Connolly AS, Dunlop K, Perera P, O’Loughlin R, Brown SJ, Krieser DM, West A, Chapman P, Lawford R, Cheek JA. Understanding parent-reported factors that influence children’s anxiety and depression presentations to Emergency Department: A multi-site study. Accepted 5 February 2020 Emergency Medicine Australasia

    Related Projects 

    Prof Hiscock is conducting related projects through the Health Services research group at MCRI. You can read more about these projects here.


    National: RCH; MCRI; University of Melbourne; Monash Children’s Hospital; Sunshine Hospital; Ballarat Hospital.

    International: USA - University of Michigan, Child Health Evaluation and Research Center (Prof Gary Freed); Ireland- Trinity College, School of Nursing and Midwifery (A/Prof Maria Brenner); Denmark, University of Southern Denmark, Centre for Global Health (Ms Stine Lundstroem).


    Victorian Emergency Minimum Dataset (VEMD); Young Minds Matter Survey (YMMS); Longitudinal Study of Australian Children (LSAC); The Royal Children’s Hospital (RCH; Epic); Australian Paediatric Research Network (APRN).

    Funding sources

    RCH Foundation; NHMRC Project Grant (‘Towards an evidence-based and equitable mental health system for children in Australia’)