Across education, health services, community and youth work settings are those faced by parents supporting young people who often feel excluded by the treatment process.
From the parent's point of view, their child might attend multiple sessions of therapy, but they then have to support the child for the rest of their life.
"Whilst parents may often have the primary responsibility of getting their children to mental health services and support those offering treatment, they often don't know anything about what goes on during therapy," Professor Ilan Katz from the University of New South Wales' Social Policy Research Centre told The Huffington Post Australia.
"Treatment is very limited and as soon as they walk out of the door, they are with their families."
Professor Katz has been involved in research that broadly evaluates the National Youth Mental Health Foundation 'Headspace' along with a range of other youth mental health services. The study, comprising an online survey of 250 parents and carers and almost 40 focus interviews, gave rise to a prominent yet simple tension: confidentiality versus care.
The right to confidentiality
When it comes to youth mental health, the provision of confidentiality is paramount -- and is what can often lead a child or young person to seek support.
"High levels of confidentiality are particularly important for Headspace where, unlike most services, you can walk in the door and receive the service," Katz said.
"Young people may be quite reluctant to walk in if they thought their parents would find out. In some cases, for example sexual health counselling, they may only access a service like that on their own."
While some surveyed parents respected this confidentiality, they felt that their role and needs were at times compromised.
The basic tension is simple: whether you offer high levels of confidentiality or whether you believe that mental health should be dealt with as a family issue.
"Some of them recognised that this was important for their children and whilst they didn't want to know the ins-and-outs of therapy, they wanted to be updated on progress," Katz said.
"From their point of view, their child might attend multiple sessions of therapy, but they then have to support the child for the rest of their life."
And this tension may be exacerbated by mental health issues of their own -- some of which have preceded having children.
Bridging the tension
"The basic tension is simple: whether you offer high levels of confidentiality or whether you believe that mental health should be dealt with as a family issue," Katz said.
But there are grey areas. And solutions can be difficult to generalise due to a diverse range of presentations.
Practitioners have a right to break confidentiality under some circumstances -- when the young person or someone else is in danger.
"In some cases, such as child abuse, the parent can be part of the problem in causing mental health issues... In others, the parent may be dealing with children who are aggressive or who are having suicidal thoughts," Katz said.
What is required is assessment by mental health practitioners on a case-by-case basis.
"We have found different practices across different services. Some of them have a very hard line and, in offering total confidentiality as part of their service, will say it is up to the child to communicate their needs with the parents.
"Others have a different view and approach mental health as more of a family issue. They will try to bring the parents in, when appropriate, with the consent of the young person."
And there are exceptions.
"Practitioners have a right to break confidentiality under some circumstances -- either when the young person or someone else is in danger," Katz said.
The role of family support
Despite such complexities, Katz believes in family support in mental health management and recovery.
This does not require day-to-day disclosures but general support is very important.
"Other than in situations where the family is damaging to the young person -- and whereby disclosing the parent would cause harm to them -- my belief is that family should be involved in treatment," Katz said.
"This does not require day-to-day disclosures (no young person wants that) but general support is very important. Otherwise, it is very difficult to know if they are improving."
This can come through taking kids to therapy, providing them with information from various sources and promoting unconditional support.
"Overall, it is very important for parents to give a message to their children (from a young age) that yes, many people have mental health problems and yes, they can be helped by seeking support."
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