Thirty-two young people were invited to take part in the study, and of these, 26 consented to participate (no one subsequently withdrew). Participants’ ages ranged from 16–22
years, with a mean age of 18
). Sixteen were young women, most were single, and fifteen lived in the same household as one or both parents. Six were still attending high school, and seven were engaged in various forms of paid employment. In order of frequency, their main reasons for attending the service were for treatment of depression and anxiety, depression, and depression and comorbid substance use (predominantly alcohol, cannabis and amphetamines) respectively. Their average length of engagement with the service was less than five months.
Sociodemographic details of participants
Four overlapping themes were identified in the data, reflecting the experience of young people accessing the enhanced primary care service: (i) school counsellors as service access mediators, (ii) service location as an access facilitator and inhibitor, (iii) encountering barriers accessing the service initially, and (iv) service funding as an access facilitator and barrier.
School counsellors as service access mediators
In this typical theme, young people who were attending school acknowledged the important role that supportive school counsellors played in facilitating access to the youth service. These participants had easy access to school counsellors, who in turn, made arrangements for the young people to get time off school, if necessary, to attend the youth service. School counsellors, in particular those who were familiar with the existence and the benefits of accessing this type of enhanced primary care facility, provided a key link between the young person and the service. Likewise, the existence of a trusting relationship between the school counsellor and the young person increased the likelihood of the latter accessing the service.
"Well I, okay, I ended up at headspace in a kind of normal way, I guess; like, I went to my school counsellor and my school counsellor made me call up headspace (Interviewee 3)."
"It was, like, pretty much organised for me, and so that made it so much easier for me. And, like, it was really accessible, and it was really available to me because I was referred to headspace by my school counsellor (Interviewee 22)."
While, overall, supportive school counsellors were regarded an important means of referral to the service, some young participants were reluctant to approach these staff because of the perception of possible breaches of confidentiality by the counsellor. This meant that the young person was unable to be referred to, or become aware of, the youth service through this route.
"Well, school counselling, I didn’t really like it that much, because, like, the school counsellor saw friends of mine that needed counselling; and it was just messy ‘cause they would have been talking about me or sort of those things (Interviewee 5)."
Service location as an access facilitator and inhibitor
In this general theme, the location of the youth service influenced access to the facility. Two contrasting sub-themes about geographical accessibility were identified. The service was easily accessible by public transport; two railway stations were located within walking distance, and bus services were even closer.
"Well, it’s [youth service] near the train station and I take the train every single day to go to school. And, so after school I’ll just take a train to … [name of suburb where the service is located], get off and walk, like, some five minutes and I’m here (Interviewee 25)."
Alternatively, even though there was public transport nearby, the service was less accessible to those whose homes were not in close proximity to public transport, did not have their own transport, or were reliant on others to bring them to the service. For some, if they did not have someone to bring them to the service then they might not have accessed the service: “… it would be pretty difficult if my mum didn’t take me ‘cause I live in [name of suburb], sort of like half an hour’s drive. But if she didn’t take me I wouldn’t come really (Interviewee 21).
Furthermore, relying on others to overcome difficulties with geographical access to the service sometimes caused problems within the home and exacerbated the young person’s already depressed state.
"It’s a little far away from my school and quite far away from where I work. So a lot of the time if I can’t get public transport, because it takes so long and I might be running late, my mum has to drive me, and it’s just like difficult for her sometimes because sometimes she’s cooking, or cleaning the house, or looking after my little brother. And a lot of times that leads to fights [arguments] and those fights lead to me being depressed (Interviewee 26)."
Encountering barriers accessing the service initially
In this variant theme, two main barriers were encountered accessing the youth service; unfamiliarity with the service, and delays in obtaining initial appointments. Unfamiliarity stemmed from a lack of knowledge of the existence of the service. Although a few young people reported that they were aware of the service’s whereabouts prior to help-seeking, others were unaware of its existence. This was more likely to be the case for those who were reluctant to approach school counsellors or no longer attended school. In such circumstances, access pathways were more wide-ranging and less assured, including self-referral or recommendations from friends and GPs who were aware of the existence of the service. In these situations, help-seeking was dependent on the young person’s or others’ prior knowledge of the service, but this was not always the case, as illustrated in the following two exemplars:
"Basically, … putting the word out and all that, ‘cause not many people know about the place [headspace], so I reckon if they had more ways of getting young people like my age … to come use it (Interviewee 11)."
"I’ve never heard anything about it before my school counsellor, so, if anything, advertise it a little bit more. (Interviewee 17)."
Another perceived access barrier was that when participants approached the service initially, they commonly encountered delays getting timely appointments with clinicians providing ongoing therapy, particularly clinical psychologists. However, once an initial appointment was gained, subsequent access was much easier.
"The waiting list; the first, the initial waiting list. Once you’re in, you can keep coming on a regular basis but to get in in the first place, there’s like a month waiting. I booked in my appointment in June, [but] I didn’t come until … [late] August; so it’s a month and a half (Interviewee 4)."
An additional perceived access barrier was that, in some circumstances, due to increased demands on the service, appointments had to prioritised, based on the assessed level of need. Those whose needs were assessed by the service’s clinicians as more acute and urgent were given higher priority over those assessed as requiring less immediate attention: “Like you get on a waiting list to get help and it takes ages; or it’s like, ‘sorry, you’re not kind of sick enough for us to look after you’” (Interviewee 4). The implication of prioritising was that for those designated as in less immediate need of assistance, it was a frustrating wait and might have deterred some from persevering with their appointment.
Service funding as an access facilitator and barrier
In this variant theme, the issue of whether youth are required to pay for treatment is an important consideration. Young people did not incur any out-of-pocket fees or charges when they accessed the youth service initially. This arrangement was made through Medicare, the Australian Government’s universal public health care system [36
], which approved a fee that the service provider could charge at each consultation, or alternatively through private health insurance reimbursement. This approach facilitated access to treatment, particularly to those from low socioeconomic backgrounds: “headspace is okay, especially for people like me, low income earners …”
(Interviewee 4). However, there was a limit (12 at the time of the study) on the number of consultations for individual therapy that the young person could receive through this scheme in a single calendar year. In essence, for those who required additional therapy and had limited financial resources, this limited ongoing access to the service. A possible consequence of this funding limitation was it might have deterred some young people from continuing their engagement with the service.
"Under Medicare you only get 12 sessions free. So who’s to say that you’re going to be cured in 12 sessions? And what happens for a young person if after the 12 sessions they still need help and they can’t afford to pay for a session? (Interviewee 2)."