International Day against Homophobia and Transphobia (IDAHO) - the official global video (Take Action) from Green House on Vimeo.

Useful mental health statistics

9% of adult men and 15% of women in Australia report same-sex attraction or having had sexual contact with someone of the same sex, although only approximately 2% actually identify as lesbian, gay or bisexual¹.

While we have come a long way in Australia, and indeed around the world, sexuality and gender diverse young people still experience much higher rates of mental ill health.

• At least 36.2% of trans people and 24.4% of gay, lesbian and bisexual people currently meet the criteria for experiencing a major depressive episode, compared with 6.8% of the general population. This rate soars to 59.3% of trans women (male to female) under 30 in a LaTrobe University study.

• More than twice as many homosexual/bisexual Australians experience anxiety disorders as heterosexual people (31% vs 14%) and over three times as many experience affective disorders (19% vs 6%). The rates are higher across any age group, country of birth, income level, area of residence or level of education/employment.

• Where differentiated data is available, it indicates that rates of depression and anxiety are highest among trans and bisexual Australians.

LGBTI people have the highest rates of suicidality of any population in Australia

• 20% of trans Australians and 15.7% of lesbian, gay and bisexual Australians report current suicidal ideation (thoughts)
• Up to 50% of trans people have attempted suicide at least once in their lives.
• Rates are 6x higher for same-sex attracted young people (20-42% cf. 7-13%)

Source: National LGBTI Health Alliance (2011)²

Resources for supporting young people

Do you know how to support a young person who is struggling with their sexuality or gender? Learn more about these identity traits and the services / support available.

• Gender + sexuality information
• Resources for health professionals
• Resources for young people

References

1. Smith, A. et al. (2003) Sex in Australia: Sexual Identity, Sexual Attraction and Sexual Experience Among a Representative Sample of Adults. Australian and New Zealand Journal of Public Health, 27(2): 138-145
2. Rosenstreich, G. (2011) LGBTI People Mental Health and Suicide. National LGBTI Health Alliance. Sydney

Working with young people I constantly hear parents complaining about the amount of time that their young people spend online. Comments like "they can't live without facebook", "I can't get them off the computer", and "they're addicted to being online" are common.

But is it addiction?

When considering if someone is addicted or dependent on something, we look at whether their use of the thing interferes with their ability to work, their relationships, and how they cope when they can't access that thing. Does not being able to access it make them feel agitated? Do they spend a lot of time and energy thinking about it? Are they spending more time online than intended? And is the use of the internet continuing despite causing more problems than benefit?

Whilst these are common features of all addictions, there is no formal recognition of online addiction yet. Some research has indicated that people who heavily use the internet and develop addiction-like behaviour are more likely to develop depression, and experience negative effects on their work, social and psychological functioning^{1, 2}. Others argue that high levels of internet use may be symptomatic of underlying mental health conditions^3-5 with the internet being the medium people use to access the thing that they are truly addicted to (eg. Gambling, shopping, or sex)³.

What is agreed is that there is increasingly problematic internet use.  Across the world the rates of problematic use is rising - 1.0-18.3% of adolescences in Western countries^6-9 and 13.7%-18.4% in Asian countries^{10, 11}. In South Korea there has been a spate of deaths relating to unwillingness to stop playing an online game, which has resulted in Internet Addiction being considered a significant mental health issue. In China this has led the government to pass laws restricting time spent on online games.

Despite this, there is not clear evidence that internet addiction does exist. What is known is that young people are at increased risk of developing problematic behaviours related to internet use as young people spend more time online due to the use of the internet as a source of support^{12, 13} and a way to develop their identity¹⁴. However, this doesn't mean that spending time online is going to lead to developing dysfunction; in many ways it can be beneficial, with research showing that time online can build social networks and support, and does not generally take the place of offline activities. Therefore, young people's online behaviour may positively influence life offline which is the opposite to an addiction.

Strategies for managing problematic internet use

If you are worried about a young person's internet use, there are several practical strategies you can recommend to young people and parents:

• Talk to the young person about the issues they see about their use. Acknowledge the benefits of time on line, and discuss ways to address the negatives
• Work with the young person to limit internet access to a reasonable level
• Remove internet devices from bedrooms and into public spaces
• Explore ways to build offline social connections - hobby groups, sport, interest based activities
• Find out what the young person is getting from online and find another way for them to get this

Comment

For more information on what young people do online:
Visit the Trends in Online Behaviour section
View the online tutorial in Technology and Young People

References

1. Young, K., Internet addiction. American Behavioral Scientist, 2004. 48: p. 402-415.
2. Beard, K.W., Internet addiction: a review of current assessment techniques and potential assessment questions. Cyberpsychology & behavior : the impact of the Internet, multimedia and virtual reality on behavior and society, 2005. 8(1): p. 7-14.
3. Widyanto, L. and M.D. Griffiths, 'Internet addiction': A critical review. International Journal of Mental Health and Addiction, 2006. 4: p. 31 - 51.
4. Southwell, B.G. and K.O. Doyle, The good, the bad, or the ugly? American Behavioral Scientist, 2002. 48: p. 391 - 401.
5. Blaszczynski, A., Internet use: In search of an addiction. International Journal of Mental Health and Addiction, 2006. 4: p. 7-9.
6. Tsitsika, A., et al., Internet use and misuse: a multivariate regression analysis of the predictive factors of internet use among Greek adolescents. Eur. J. Pediatr, 2009. 168(6): p. 655-665.
7. Ferraro, G., et al., Internet addiction disorder: an Italian study. Cyberpsycholology and Behaviour, 2007. 10(2): p. 170-175.
8. Johansson, A. and G. Gotestam, Internet addiction: characteristics of a questionnaire and prevalence in Norwegian youth (12-18 years). Scand. J. Psychol, 2004. 45: p. 223-229.
9. Roe, K. and D. Muijs, Children and computer games. Eur. J. Commun, 1998. 13(2): p. 181-200.
10. Kanwal, N. and D.A. Archana, Internet addiction in students: a cause of concern. Cyberpsychology and Behaviour, 2003. 6(6): p. 653-656.
11. Kim, K., et al., Internet addiction in Korean adolescents and its relation to depression and suicidal ideation: a questionnaire survey. Int. J. Nurs. Stud. , 2005. 43: p. 185-192.
12. Gould, M.S. and et al., Seeking help from the internet during adolescence. . J Am Acad Child Adolesc Psychiatry, 2002. 41(10): p. 1182-9.
13. Burns, J.M. and et al., The internet as a setting for mental health service utilisation by young people. Med J Aust, 2010. 1921(11 Suppl): p. S22-6.
14. Leung, L., Stressful life events, motives for Internet use, and social support among digital kids. Cyberpsychology and Behaviour, 2007. 10(2): p. 204-214.

Sleep has a HUGE impact on our wellbeing

Sleep is our body's time to heal, and evidence shows that if we don't get enough sleep it can affect the development of our brains and our bodies. Yet unhealthy sleeping patterns are on the rise. Constant access to the internet, more accessible unhealthy food options and in many cases less exercise, are all factors in the increase in poor sleeping habits among young people. More often than not people try to make up for lack of sleep on the weekend - which just doesn't cut it.

Online forum on sleep + wellbeing: Thursday 10 May, 9:30pm AEST

To answer questions about healthy sleeping habits, it's impact on our wellbeing, and how to manage it, we are hosting a guest psychologist from Youth Focus in WA, to talk to young people about sleep.

LINK: http://forums.reachout.com/showthread.php?2370-May-10-Sweet-dreams-are-made-of-this

Have a question for Rich about sleep? He will answer it on the night, during the Infobus discussion. Submit it here or email sophie@inspire.org.au

The ReachOut.com forums are a safe space where young people are encouraged to connect with others who have been through similar issues and talk about these issues in a positive productive way. It's a valuable support community, and can provide additional support between sessions for young people you are working with.

Practical resources to use with young people

• How does sleep affect our wellbeing?
• Sleeping issues
• Circadian rhythms and depression

"Interesting fact: Lots of people have later sleeping rhythms, making it harder to wake early, but meaning that we are more alert later in the day. This has prompted many sleep specialists to advocate for later school start and finish times across the country, to accommodate for when we are functioning most effectively."

- c/o Lauren, ReachOut.com Youth Ambassador

The draft paper is now available for viewing on the ACARA website at http://www.acara.edu.au/hpe.html.

The draft Shape of the Australian Curriculum: Health and Physical Education outlines the direction for the development of the national Health and Physical Education curriculum for years F - 12. Following consultation, all feedback will be analysed and used to revise the draft document before it is published as The Shape of the Australian Curriculum: Health and Physical Education.

ReachOut.com youth consultation

ACARA is working with ReachOut.com to canvas the perspectives of young people on what should be included in the Health and Physical Education Curriculum, specifically with regards to mental health. We are asking young people what they missed out on in health class. And we're telling it to the people that count.

This is the first time so many young people have been actively consulted on a curriculum. It's an *awesome/unheard of* opportunity for young people to have their say on what health topics matter to them.

What did you miss out on in Health Class? What do you think should be included in Health class? Whether you're still in school, long graduated, or somewhere in between, you can have your say on the Australian schools health curriculum.

How to participate

When? Wednesday the 2nd of May 2012 at 7.30 PM AEST
Where? on the ReachOut.com Facebook page

Further information on the development of the national Health and Physical Education curriculum, including a proposed timeline, can be accessed on the ACARA website - http://www.acara.edu.au/hpe.html.

Challenge the negative

For a lot of young people it can be hard to conceptualise that negative patterns of thinking can be severe barriers to tackling life problems. Negative thinking also lies at the root of many common mental health disorders.

United States actress Monique Coleman, best known for playing Taylor McKessie in the "High School Musical", talks to ReachOut.com about positive thinking. Original link: http://au.reachout.com/rotv/Staying%20Healthy/watch/monique-coleman-on-positive-thinking

Negative thinking online discussion: Thursday 12 March, 9:30pm AEST

ReachOut.com are highlighting negative thinking and ways to tackle it this week in an online discussion with special guest Sophia - a psychologist from Youth Focus in WA.

LINK: http://forums.reachout.com/showthread.php?2266-Challenging-Unhelpful-Negative-Thoughts-April-Infobus

The ReachOut.com Forums

The ReachOut.com forums are a safe space where young people are encouraged to connect with other young people who have been through similar issues and talk about these issues in a positive productive way. The forums provide a valuable support community for young people seeking to improve their mental health and wellbeing, and can provide additional support between sessions for young people you are working with.

Practical resources to use with young people

• Challenging negative self talk - online resources
• The Zen Den (ReachOut.com) - online forum on positive thinking

Article by Liesje Donkin, Clinical Consultant for ReachOut Pro

Deliberate self-harm (DSH) is an issue that tends to divide clinicians, consumers and parents alike. Many people cannot understand what would drive someone to deliberately hurt themselves regardless of how much pain they are feeling. I mean, creating pain to manage pain seems stupid right? So the purpose of it must be attention seeking?

Why do young people self-harm?

Labelling DSH as attention seeking is invalidating and potentially dangerous. Whilst some people who DSH may do so to communicate their distress, they can also do it for a number of other reasons. These reasons include to help them feel when they are emotionally numb; to distract themselves from the pain they are experiencing emotionally; to regulate themselves emotionally; to punish themselves; or to disfigure themselves. Importantly, DSH is not intended as a way to end their lives¹.  However, there is an increased risk of suicide in those people that do DSH² with the risk of suicide increasing with episodes of DSH³.  For these reasons, DSH carries very real risk and should not be considered as attention seeking.

What should I do if a young person discloses self-harm?

First and foremost, be non-judgemental. It's often difficult for young people to talk about their DSH, particularly when people haven't reacted well to it previously. Many are also concerned that their parents or loved ones might get told. Covering confidentiality is therefore important to ensure the continuity of the therapeutic relationship so that the young person can continue to feel comfortable working with you.

Checking safety is also key. If the conversation occurs in each session it can help the young person feel more comfortable with discussing DSH and suicidal ideation. It becomes the norm and gives them the opportunity to discuss it without having to raise it. Creating such a space in each session can build trust and can be aided by the use of diaries or apps to record the behaviour.

Treatment options

Finally, it's important to consider how to treat DSH in session. It can be useful to work with the client to place some hurdles to DSH. This might include removing objects from the location which the young person engages in DSH or reducing the time they spend in isolation. Determining the function of the DSH is also useful so that an alternative behaviour can be substituted for it^4,5. For example, if the behaviour provides a physical distraction then high intensity exercise may work as a substitute. Alternatively, squeezing ice or biting down on a lemon may work.  Whilst these behaviours work for some young people, they might not work for all.  Given this, it's important to work with the young person to develop a list of alternative behaviours that they can use to distract themselves from their DSH urges so that they can build their confidence in coping without it.  Finally, ensuring that a safety plan is in place to help the young person through their difficult time is an important part of any management plan.

Comment

For more information on self-harm, or to access ReachOut.com fact sheets and stories you can use with a young person, visit the Suicide and Self Harm section of the ReachOut Pro Mental Health Information.

References

1. Skegg, K., Self-harm. Lancet, 2005. 366(9495): p. 1471-83.
2. Hawton, K., D. Zahl, and R. Weatherall, Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital. The British journal of psychiatry : the journal of mental science, 2003. 182: p. 537-42.
3. Zahl, D.L. and K. Hawton, Repetition of deliberate self-harm and subsequent suicide risk: long-term follow-up study of 11,583 patients. The British journal of psychiatry : the journal of mental science, 2004. 185: p. 70-5.
4. Muehlenkamp, J.J., Empirically supported treatments and general therapy guidelines for non-suicidal self-injury. Journal of Mental Health Counseling, 2006. 28(2): p. 166-185.
5. Klonsky, E.D. and C.R. Glenn, Resisting Urges to Self-Injure. Behavioural and Cognitive Psychotherapy, 2008. 36(2): p. 211-220.

Cyber-savvy: Ways to get proactive on cyberbullying

How do you deal when friends (or even enemies!) take bullying online? Cyberbullying can be really traumatic, when the things that are being said are done against you are happening in a 24/7 public space, or pursuing you into your home.

Monday on ReachOut.com young people will be getting proactive about cyberbullying, taking the discussion into the online forums about how they can respond positively to cyberbullying, and reduce the impact it has on your mental wellbeing.

Cyberbullying discussion forum: Monday 26th March, 8:30pm AEST

LINK: http://forums.reachout.com/forumdisplay.php?6-Getting-Real-open-every-Monday-Night-from-8.00pm-AEST

Resources for professionals:

• Cyberbullying: The facts

Resources to give to young people:

• Cyberbullying: What it is and how to get help
• Bullying: Know your rights
• Being a supportive bystander

Reflect, relax, and gain some perspective

In the "Zen Den" section of the ReachOut.com mental health forums, young people create, share and take part in online activities to help them put bad things in perspective and think about the good things in life. As of this week, Turning Negatives Into Positives and Three Positives of Today have been viewed over 62,000 times.

LINK: http://forums.reachout.com/forumdisplay.php?43-Zen-Den

The ReachOut.com Forums

The ReachOut.com forums are a safe space where young people are encouraged to connect with other young people who have been through similar issues and talk about these issues in a positive productive way. The forums provide a valuable support community for young people seeking to improve their mental health and wellbeing, and can provide additional support between sessions for young people you are working with.

For more info about online safety and managing privacy, visit the Online Safety section of ReachOut Pro

A young person with depression walks into a doctor's office. What happens next? You assess the patient and a find that they are indeed suffering from Depression. Perhaps you next decide to refer your patients for further specialist help put them on an antidepressant medication. But which medication do you prescribe them? You could prescribe them a common SSRI such as Lexapro or Zoloft or maybe you prescribe them an SNRI such as Effexor. The patient leaves and begins their course of medication. You then see your patient again some months later and find out how they are faring on their medication. Is it working? Is it not working? If so, great! If not, repeat… repeat…repeat… But is guesswork in prescribing serious life changing medications really acceptable?

Now we know that three-quarters of the antidepressant prescriptions prescribed in primary care management is initiated by a GP¹. We also know that Depression is the fourth most commonly managed problem in general practice in Australia². So what if there was a way you could assess your patient on that first visit and using evidence based research, come up with an initial prescription that is much more likely to work based on biological factors uncovered on  that initial assessment? This would take out the trial and error factor of prescribing antidepressants and give you a much better shot at nailing it the first time, greatly increasing your patients' chance at recovery. Young people are in their formative years and time is of the essence.

This research is currently well under way and that preliminary data has shown tangible biological markers that can actually predict treatment response in depression. The project is called iSPOT-D (or International Study to Predict Treatment Optimization in Depression) and is based at the Brain Dynamics Center, Westmead Millennium Institute at Westmead Hospital. Over 1000 participants with depression have participated in the study globally and we are seeing some great results.

These results will be published soon, so watch this space. But the underlying question we are trying to answer is a question that we should all be asking. You are prescribing antidepressants and, in general, they are working. There are definite benefits and a need to explore these benefits. But how can we make this process more efficient? How can we get better at this? We need these Biomarkers to make educated treatment decisions, not 'stab in the dark' decisions. How do you decide what treatments to give your patients with depression?

For more information visit http://www.brain-dynamics.net/our-studies/depression or phone 9845 8195.

Not familiar with mood disorders, and want to learn more? Visit the mood disorders section of ReachOut Pro

References

1. Britt H, Miller GC, Knox S, Charles J, Pan Y, Henderson J, Bayram C, Valenti L, Ng A, O'Halloran J (2005). General practice activity in Australia 2004-05. AIHW Cat. No. GEP 18. Canberra: Australian Institute of Health and Welfare (General Practice Series No. 18).
2. McManus, P., Mant, A., Mitchell, P.,Britt, H., Dudley, J. (2003) Use of antidepressants by general Practictioners and psychiatrists in Australia. Aust N Z J Psychiatry. 37(2):184-9

Young People and Technology

Next week, we're going to be getting into the nitty gritty of tech and young people - the time they spend online, the impact on their sleep and anxiety, and how to minimise the risks of living in a digital world.

Worried young people you work with are too switched on? Encourage them to check out Monday's Getting Real session on the forums!

Monday 12th March, 8:30pm AEST

LINK: http://forums.reachout.com/forumdisplay.php?6-Getting-Real-open-every-Monday-Night-from-8.00pm-AEST

New tips in the toolbox

On the ReachOut.com forums, young people collate and share their top tips, strategies and activities for managing their mental health, building resilience, and dealing with crisis. There's some great new activities being shared by young people at the moment - check them out!

LINK: http://forums.reachout.com/forumdisplay.php?23-Toolbox

The ReachOut.com Forums

The ReachOut.com forums are a safe space where young people are encouraged to connect with other young people who have been through similar issues and talk about these issues in a positive productive way. The forums provide a valuable support community for young people seeking to improve their mental health and wellbeing, and can provide additional support between sessions for young people you are working with.

For more info about the time young people spend online, the benefits and negatives, and how to manage safety risks, visit the Using Technology section

Self Harm Help - Self injury awareness day

Today is Self Injury Awareness day, and over on the ReachOut.com Forums we've created a thread with fact sheets for helping people who self harm, stories about overcoming it, and resources to share with others.

LINK: http://forums.reachout.com/showthread.php?2182-Self-Harm-help

Depression - Talking about the serious side

Next Thursday on ReachOut.com we'll be hosting a guest youth worker, who will be facilitating a discussion around depression. We'll be talking about what Depression is, how it's managed, and sharing stories and support strategies around dealing with this tough mental health disorder.

Thursday 8th March, 7:30pm WST (10:30 AEST)

LINK: http://forums.reachout.com/forumdisplay.php?5-Infobus-and-Features-Guests

The ReachOut.com Forums

The ReachOut.com forums are a safe space where young people are encouraged to connect with other young people who have been through similar issues and talk about these issues in a positive productive way. The forums provide a valuable support community for young people seeking to improve their mental health and wellbeing, and can provide additional support between sessions for young people you are working with.

For resources on self harm, depression, and other mental health difficulties, browse the mental health information section of ReachOut Pro