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Approaches to improving people’s mental health fall across a spectrum from those targeting risk and protective factors in healthy individuals to those targeting individuals with mental illness. Common to all approaches is a focus on mental health literacy, improving people’s knowledge about mental health and how it is fostered. Communication designers are not typically involved early in the development of mental health literacy campaigns or products, reflecting a prioritization of the mental health content. This article reports on the benefits of an interdisciplinary collaboration between mental health clinicians, undergraduate communication design students and tertiary design educators, called Visualizing Mental Health, which takes a different approach. Mental health concepts are used to inspire designers to create unique prototypes including games, apps, toys, and books. The development of these prototypes emerges from design thinking and creative idea generation methods. A key to the development of these outcomes is a focus on deliberately open-ended briefing, through which the creative skills of participating communication designers are expressed prior to finalization of client parameters. This approach in a mental health intervention context over a six-year period has attracted attention from mental health sector funding and led to the development of pilotable interventions into mental health literacy. Refereed/Peer-reviewed

Objective: To provide outcome benchmarks for evaluating student psychologist‐led training clinics providing outpatient adult cognitive behaviour therapy (CBT) for high prevalence disorders, and illustrate their application to the evaluation of a South Australian community mental health‐based psychology training clinic: The Centre for Treatment of Anxiety and Depression (CTAD). Method: Study 1 derived aggregated uncontrolled effect sizes and clinically significant change rates for the CBT and control conditions of randomised controlled trials (RCTs), with critical values for demonstrating equivalence to RCTs and superiority to control conditions for anxiety disorders and depression. Study 2 provided benchmarks for demonstrating equivalence, and superiority to other student clinics. Study 3 calculated outcome effect sizes and clinically significant change rates of 342 consecutive CTAD clients allocated to student psychologists between 2009 and 2015, who provided at least two questionnaires, attended at least three sessions and were primarily seen by a student therapist. Aggregated point prevalence estimates of key demographic characteristics of studies contributing to benchmarks were provided. Results: RCT CBT produced higher effect sizes than student clinics, but similar rates of clinically significant change. The application of benchmarking to CTAD illustrated that evaluations of student psychologist effectiveness would differ depending on the benchmark used. Conclusion: We have provided best‐available benchmarks for evaluating student‐led adult outpatient CBT which we encourage other student clinics to adopt. The benchmarking approach provided a profile of CTAD's strengths and weaknesses. Examples of how benchmark comparisons could be used to inform service improvement were provided. Refereed/Peer-reviewed

A previous review on the prevalence of psychopathology in siblings of children with mental health problems (MHPs) suggested that these siblings are at increased risk of a broad range of psychopathologies. No disorder-specific risk could be identified. It may be that a different approach to understanding mental health is needed. The following paper aimed to explore if using a dimensional approach could provide greater clarity and insight into the mental health of these siblings by conducting a similar systematic review using dimensional data on the psychosocial functioning of siblings of children with MHPs. An electronic search of publications from 1990 to 2011 identified 29 articles. The findings show that while mean sibling scores on internalising problems, externalising problems, social problems were in the normal range compared to standardised norms, siblings of children with MHPs scored poorer than control children and a greater proportion of siblings scored in the borderline/clinical range compared to children in the general population. Particular areas of functional impairments identified were delinquent behaviour, somatic complaints, anxious/depressed behaviour, and social problems. Effect sizes were moderate to large. Findings on symptom scores with categorical underpinnings were inconsistent.Implications for the debate between dimensional and categorical approaches are discussed and guidelines for future research are outlined. Implications for clinical treatment for siblings are highlighted. Refereed/Peer-reviewed

Background During COVID-19, the psychological distress and well-being of the general population has been precarious, increasing the need to determine the impact of complementary internet-based psychological interventions on both positive mental health as well as distress states. Psychological distress and mental well-being represent distinct dimensions of our mental health, and congruent changes in outcomes of distress and well-being do not necessarily co-occur within individuals. When testing intervention impact, it is therefore important to assess change in both outcomes at the individual level, rather than solely testing group differences in average scores at the group level. Objective This study set out to investigate the differential impact of an internet-based group mental health intervention on outcomes of positive mental health (ie, well-being, life satisfaction, resilience) and indicators of psychological distress (ie, depression, anxiety, stress). Methods A 5-week mental health intervention was delivered to 89 participants using the Zoom platform during 2020. Impact on outcomes of distress, well-being, and resilience was assessed at the start and end of the program with multiple analysis of variance (MANOVA) and reliable change indices (RCIs) being used to determine program impact at the group and individual levels, respectively. Results The intervention significantly improved all mental health outcomes measured, (F6,83=5.60, P Conclusions The results provide evidence for the significant impact of an internet-based mental health intervention during COVID-19 and indicate the importance of assessing dimensions of both well-being and distress when determining mental health intervention effectiveness.

Objective: This study sought to understand the perspectives of young people (12-25 years) with experience of mental health services on what makes for youth-friendly mental health services.Method: A purposive strategy was used to recruit 32 young people aged 12-25 years with diverse backgrounds, through mental health and youth services. Six semi-structured group interviews were undertaken and one individual interview. We were especially interested in aspects that facilitated or obstructed young people from seeking help, and key experiences across their consumer journey. Transcripts were analysed thematically to identify shared experiences and perspectives across the interviews.Results: Five key themes emerged: the central role that teachers, school counsellors, parents, and friends play in help seeking and responding to crisis; the impact of fear, uncertainty, and stigma in decision-making and engaging with services; finding the right therapist and effective help; ways to improve flexibility and ease of access; the need for better quality consumer information for accessing a mental health service.Discussion: The results of the study have implications for the design of mental health services, providing important insights that can increase young people's engagement with services, and ultimately, improve the mental health and well-being of young people in Australia. Refereed/Peer-reviewed

Objectives: The prevention of mental illness involves identifying and modifying those characteristics and exposures of an individual that threaten their mental health – commonly referred to as risk factors. Existing categorisations of risk factors for mental illness are either limited in their scope or oversimplified in their description. As part of a large mental health workforce and service planning project, we set out to develop a more detailed and comprehensive categorisation scheme to describe risk factors for mental illness. Methods: We conducted a rapid review of MEDLINE and Google Scholar for meta-analytic studies that examined the characteristics and exposures that typify the population with mental illness in order to identify and categorise potential risk factors. Results: The search uncovered 1628 relevant studies, from which 10 primary and 23 secondary categories of risk factors were identified, ranging from genetic and biomedical to psychological and sociocultural. The review revealed interesting distortions in the focus of the literature, with the majority of studies focused on a few disorders (schizophrenia, depression and neurodegenerative disorders) and genetic, psychological and physiological risks. In contrast, environmental (e.g. media exposure) and occupational (e.g. employee health) were under-represented. Conclusion: The categorisation scheme developed in this paper is a step towards a more detailed taxonomy of risk factors for mental illness; this will be most useful in guiding clinicians, researchers and policy-makers in driving the prevention agenda forward.

While it is well recognized that family relationships have a significant impact on child mental health and vice versa, little research has examined the impact of living with a child with mental health problems (MHPs) on family relationships for their siblings. This report aims to synthesize the existing literature and comment on the current state of evidence. An electronic search of publications from 1990 to 2011 was conducted and 22 studies were included. The findings show that families of children with MHPs have less positive (e.g. less supportive) and more negative (e.g. more conflictual, aggressive) sibling relationships and more negative parent-sibling relationships compared to control families. Exceptions were sibling relationships in families of children with conduct disorder (more positive) and anxiety disorders (not significantly different from controls). Limitations of the existing literature include the types of measures used and the use of single informants. Methodological guidelines for future studies are outlined. Refereed/Peer-reviewed

Summary Background High-quality mental health services for infants, children, adolescents, and their families can improve outcomes for children exposed to early trauma. We sought to estimate the workforce needed to deliver tertiary-level community mental health care to all infants, children, adolescents, and their families in need using a generalisable model, applied to South Australia (SA). Methods Workforce estimates were determined using a workforce planning model. Clinical need was established using data from the Longitudinal Study of Australian Children and the Young Minds Matter survey. Care requirements were derived by workshopping clinical pathways with multiprofessional panels, testing derived estimates through an online survey of clinicians. Findings Prevalence of tertiary-level need, defined by severity and exposure to childhood adversities, was estimated at 5–8% across infancy and childhood, and 16% in mid-adolescence. The derived care pathway entailed reception, triage, and follow-up (mean 3 h per patient), core clinical management (mean 27 h per patient per year), psychiatric oversight (mean 4 h per patient per year), specialised clinical role (mean 12 h per patient per year), and socioeconomic support (mean 12 h per patient per year). The modelled clinical full-time equivalent was 947 people and budget was AU$126 million, more than five times the current service level. Interpretation Our novel needs-based workforce model produced actionable estimates of the community workforce needed to address tertiary-level mental health needs in infants, children, adolescents, and their families in SA. A considerable expansion in the skilled workforce is needed to support young people facing current distress and associated family-based adversities. Because mental illness is implicated in so many burgeoning social ills, addressing this shortfall could have wide-ranging benefits. Funding National Health and Medical Research Council (Australia), Department of Health SA.

Objectives: The study aim was to estimate the current level of ambulatory mental health service delivery to young people aged 0–24 years in Australia and associated government expenditure. Recognising the importance of the early years for the development of mental illness and socioeconomic outcomes, we were particularly interested in service access by infants and young children. Methods: We extracted information from government administrative datasets on the number of people who received mental health services, number of services and expenditure through the health sector for 2014–2015. Results are primarily reported by age groups 0–4, 5–11, 12–17 and 18–24 years. Results: Less than 1% of 0- to 4-year-olds received a mental health service in any one service setting, whereas nearly 11% of 18- to 24-year-olds received a mental health service through the Medicare Benefits Schedule Better Access programme alone. Many more services were delivered to 12- to 24-year-olds (>4 million) than to 0- to 11-year-olds (552,000). Medicare Benefits Schedule Better Access delivers services to more children and youth than do state/territory community mental health services, although the latter provide more services per client. In 2013–2014, Australian Government expenditure on ambulatory mental health services for 0- to 24-year-olds was AUD428 million, similar to the AUD491 million spent by state/territory governments. Conclusion: The study provides a benchmark for data-driven service planning to ensure that the mental health needs of infants, children and young people are met. Our results indicate that the youngest age group are underserviced relative to need, even noting infants and children may receive services for behavioural/mental health issues from providers not captured in our study (such as paediatricians). The developmental origins of mental illness underlies the urgency of adequate provision by governments of perinatal, infant and child mental health services to avoid loss of life potential and reduce the pressures on the justice, child protection and welfare systems.

Background: Siblings of children with mental health problems (MHPs) have been found to have higher rates of psychopathology and impaired psychosocial functioning compared to control children. It is not yet known how these siblings are managed within the clinical service context (e.g. are they assessed for mental health problems? Do they receive appropriate psychological treatment?). Aims: The following brief report describes a pilot study which aimed to explore (a) the rate of caregiver-identified MHPs in siblings and (b) the proportion of siblings receiving psychiatric or psychosocial treatment or support (i.e. treatment utilisation). Methods: Eighty-five caregivers of children receiving treatment at CAMHS were interviewed about the mental health and treatment utilisation of their siblings. Results: The findings revealed a high rate of caregiver-identified MHPs in siblings (34.1%) and a high rate of treatment utilisation (85.7%). Conclusions: The findings suggest that, for the vast majority, when siblings of children with MHPs are identified by their caregivers as having MHPs, they are receiving some kind of support and treatment. Implications for mental health service costs are discussed and recommendations for future research are outlined. Refereed/Peer-reviewed

Qualitative metasynthesis is an interpretive integration of primary qualitative research. It is a relatively new research methodology with questions remaining about utility, validity, and qualitative philosophical integrity. The aim of this article is to present an example of qualitative metasynthesis and to explore the utility, interpretive value, and clinical applications of metasynthesis in advancing our knowledge of the wellbeing and needs of siblings of children with mental health problems. An electronic search of publications from 1990–2011 was conducted. Ten articles were included and analyzed using thematic synthesis and constant targeted comparison. Qualitative metasynthesis allowed novel interpretations beyond those found in primary research in terms of theoretical frameworks and clinical implications. In addition, qualitative metasynthesis produced findings greater in depth and consistency and with more direct clinical implications than primary research and quantitative reviews. Qualitative metasynthesis provides a pathway by which more conclusive, reliable, and generalizable findings are produced and interpretive power and clinical utility are increased. It represents a significant advancement in qualitative methodology with the potential to provide unique contributions to research, theory, and evidence-based practice. (PsycINFO Database Record (c) 2015 APA, all rights reserved) Refereed/Peer-reviewed

Objective: To estimate the prevalence of children in the Australian population with risk factors for adult mental illness. Method: Key risk factors and risk domains were identified from a 2013 review of longitudinal studies on child and adolescent determinants of adult mental illness. Data items were identified from the Longitudinal Study of Australian Children that map onto the risk domains and were used to estimate the prevalence of these key individual risk factors and the magnitude of multiple risk in children aged 3 months to 13 years. Results: Even by infancy, risk factors for adult mental illness are highly prevalent, with 51.7% of infants having multiple risks. In 10 infants, 1 was born to mothers who consumed daily alcohol and 1 in 8 to mothers who smoked cigarettes daily during pregnancy. Also, 10.5% of infants were in families where the parents had separated, which increased to 18% in 10–11 year-olds. Psychological problems in the clinical range (based on the Strengths and Difficulties Questionnaire total problems score) ranged from 7.8% to 9.7% across the 4–13 years age range. Risks from negative parenting behaviours were highly prevalent across age groups. Two-thirds of children aged 12–13 years had parents who displayed low warmth or exhibited high hostility/anger. Across childhood, one in seven children are in families exposed to 3+ major life stressors. By age 8–9 years, more than 18% of children are exposed to ⩾5 risk factors. Conclusions: We find that modifiable risk factors for adult mental illness occur at the earliest stage in the life course and at greater prevalence than is commonly recognised. Considerable capacity will be required in child and adolescent mental health services and complementary family support programmes if risk factors for adult mental illness that are already apparent in infancy and childhood are to be addressed.

Background: Mental illness is prevalent across the globe and affects multiple aspects of life. Despite advances in treatment, there is little evidence that prevalence rates of mental illness are falling. While the prevention of cardiovascular disease and cancers are common in the policy dialogue and in service delivery, the prevention of mental illness remains a neglected area. There is accumulating evidence that mental illness is at least partially preventable, with increasing recognition that its antecedents are often found in infancy, childhood, adolescence and youth, creating multiple opportunities into young adulthood for prevention. Developing valid and reproducible methods for translating the evidence base in mental illness prevention into actionable policy recommendations is a crucial step in taking the prevention agenda forward. Method: Building on an aetiological model of adult mental illness that emphasizes the importance of intervening during infancy, childhood, adolescence and youth, we adapted a workforce and service planning framework,originally applied to diabetes care, to the analysis of the workforce and service structures required for best-practice prevention of mental illness. Results: The resulting framework consists of 6 steps that include identifying priority risk factors, profiling the population in terms of these risk factors to identify at-risk groups, matching these at-risk groups to best-practice interventions, translation of these interventions to competencies, translation of competencies to workforce and service estimates, and finally, exploring the policy implications of these workforce and services estimates. The framework outlines the specific tasks involved in translating the evidence-base in prevention, to clearly actionable workforce, service delivery and funding recommendations. Conclusions: The framework describes the means to deliver mental illness prevention that the literature indicates is achievable, and is the basis of an ongoing project to model the workforce and service structures required for mental illness prevention. Refereed/Peer-reviewed

KESSLER 10 FOR USE IN YOUTH MENTAL HEALTH OUTREACH SERVICES Gareth Furber, PhD, Ann E Crago, Tom D Sheppard, Clive Skene (Clinical Psychology) Health Economics and Social Policy Group, School of Population Health, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, SA, 5000; Bachelor of Nursing Youthlink, Women’s and Children’s Health Network, SA Health, GP Plus Health Care Centre Marion, 10 Milham Street, Oaklands Park, Adelaide, SA, 5046; Registered Nurse (Mental Health) Youthlink, Women’s and Children’s Health Network, SA Health, GP Plus Health Care Centre Marion, 10 Milham Street, Oaklands Park, Adelaide, SA, 5046; Master of Psychology CAMHS Executive, Level 1, 55 King William Road, North Adelaide, SA, 5006 Corresponding Author: E gareth.furber@unisa.edu.au

Introduction In Australia there is an overwhelming need to provide effective treatment to patients presenting to the Emergency Department (ED) in mental health crisis. We adapted Improving Access to Psychological Therapies service model (IAPT) from the National Health Service (NHS) method for the large scale delivery of psychological therapies throughout the United Kingdom to an Australian ED setting. This telephone-based low intensity therapy was provided to people presenting in crisis to the EDs with combinations of anxiety, depression, substance use, and suicidal thinking. Methods This uncontrolled study utilised session-by-session, before-and-after measures of anxiety and depression via Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7). Results Of 347 eligible post-crisis ED referred patients, 291 (83.9%) engaged with the IAPT team. Most patients (65%) had attended the ED previously on an average of 3.9 (SD = 6.0) occasions. Two hundred and forty one patients received an average of 4.1 (SD = 2.3) contacts of low-intensity psychological therapies including 1.2 (SD = 1.7) community outreach visits between 20th Oct 2011 and 31st Dec 2012. Treated patients reported clinically significant improvements in anxiety, depression and suicidal ideation. Uncontrolled effect sizes were moderate for anxiety (0.6) and depression (0.6). Discussion The Australian ED IAPT program demonstrated that the UK IAPT program could be adapted for emergency mental health patients and be associated with similar clinical benefits as the original program. Funding The Flinders Medical Centre IAPT program received Emergency Department project funding from the Australian Commonwealth Government through the Council of Australian Governments (COAG) and the South Australian Government initiative, Every Patient Every Service (EPES).