Mental health is a dynamic spectrum that ranges from a state of wellbeing, through mental distress, to mental disorder or illness. Written for a broad primary healthcare audience, this article offers help with navigating youth mental health.
Time to focus on youth mental health
Youth (people aged 12–25 years) in Aotearoa New Zealand are reporting worsening emotional and mental health, and inequities for our young Māori and Pacific peoples are growing. We, as healthcare professionals, have obligations under Te Tiriti o Waitangi to provide equitable health outcomes for Māori. This is not being achieved for the mental health of rangatahi Māori.
Key points
- The emotional and mental health of our youth population appears to be worsening, with persistent and widening inequities for Māori and Pasifika.
- Terms such as “distress”, low mood” or “tough times” help to avoid over-medicalising; only use “depression” when there is a diagnosis.
- Antidepressants are not indicated first-line for mild to moderate depression, and are not registered for use in people aged under 18.
- Have a list of personnel/services you can call on immediately, including a youth health voice/champion in your practice to help promote and deliver timely services.
- Addressing the taiao and iwi katoa (physical environment and societal structures) is fundamental to improving youth mental health.
Illustrative scenario
A distressed 16-year-old Māori female presents with a whānau member at your next clinic. There is an expectation of an antidepressant prescription. You establish a relationship and gain trust of the young person, including seeing them alone for at least part of the time and explicitly discussing confidentiality. There are no safety issues that you can determine, but you discover they have recently withdrawn from their chosen course of study and feel constrained by their current housing situation. Previously a keen sportsperson, they feel unable to pursue any of their chosen activities. What options do you have to help the young person? Is a prescription for an antidepressant reasonable? Are there models of care available that would be helpful to this young person?
Youth/rangatahi emotional and mental health worsening
The latest Youth2000 national health and wellbeing survey (one of a series of surveys undertaken in 2001, 2007, 2012 and 2019) has reported that youth emotional and mental health is significantly worsening, with “persistent and growing mental health inequity between Māori and other ethnic groups”.1,2 For example, depressive symptoms (measured with the Short Form Reynolds Adolescent Depression Scale) increased from 13 per cent in 2012 to 23 per cent in 2019 for youth in secondary schools.1
It should be noted that “depressive symptoms” does not necessarily indicate a diagnosis of depression but does acknowledge that the person is likely to have clinically significant symptoms of depression that affect them in their daily life.1
In the 2019 survey, there were significant disparities between ethnicities, with 27.9 percent of Māori youth, 24.6 per cent of Pacific youth, 24.5 per cent of Asian youth, and 19.6 per cent of Pākehā/Other European youth reporting depressive symptoms.1
Furthermore, for Māori, there was a marked increase in depressive symptoms from 13.8 per cent in 2012 to 27.9 per cent in 2019 (relative risk 2.01) compared with a RR of 1.58 for Pākehā over the same period.3
Both Māori (13 per cent) and Pacific (12 per cent) youth are four times more likely to attempt suicide than Pākehā youth (3 per cent).4
Despite higher health need, Māori youth experience significant challenges and barriers to accessing healthcare, with 26.9 per cent reporting an inability to access healthcare when needed (increasing from 21.6 per cent in 2012; RR 1.25) compared with 16.5 per cent of Pākehā youth (increasing from 15.3 per cent in 2012; RR 1.25).3
SSRI prescribing rates rising
Alongside worsening youth mental health and growing inequities, there is increasing prescribing of selective serotonin reuptake inhibitor (SSRI) antidepressants.5 This is demonstrated with dispensing data in the He Ako Hiringa EPiC dashboard showing year-on-year increases in SSRIs and other antidepressants over the last four years among youth of all ethnicities (Māori, Pacific peoples, Asian, European/Other).6 Increased prescribing could be due to growing rates of mental health problems, increasing awareness, a lack of access to talking therapies, or other factors.
Call to action
A recent report from Te Hiringa Mahara (The Mental Health and Wellbeing Commission) identified racism and discrimination, impacts of poverty (ie, food and housing insecurity), social media, whānau wellbeing and uncertainty about the future as some of the main factors affecting the wellbeing of young people. The report recommends that young people have a voice in decisions that affect them and that they actively participate in these decisions.7
There are many theories about why mental health is worsening, but key elements include the importance of the taiao/iwi katoa (physical environment and societal structures that provide support), rather than individual personal factors.
Diagnosis is challenging
Primum non nocere (first, do no harm); avoid over-medicalising.
Diagnosis of mental health conditions can be difficult in young people as comorbidity is common.8 There may also be substance abuse, behavioural concerns and prior youth justice involvement. Some periods of low mood and distress may be precipitated by events or trauma and be a normal developmental response. In these situations, it is important to avoid diagnostic labels and to instead use terms such as distress, low mood, or tough times.
A diagnosis can also be challenging for whānau but may, in some cases, facilitate access to support (eg, diagnosing neurodevelopmental challenges may help with getting educational support).
Holistic approach needed
Sometimes antidepressants, in conjunction with talk therapies and other support systems, can be useful when supporting young people through a difficult time (see later). Care must be taken, however, to not prescribe psychotropic medicines to someone having an appropriate developmental response to their situation or environment, without trying to address the issues causing distress and looking at other solutions.
This is where multidisciplinary primary care teams – with social workers, Māori community health workers, health improvement practitioners, health coaches and youth workers – can strengthen the wellbeing of whānau. The greatest impact on the individual may be through improving their social situation and addressing the taiao/iwi katoa (systems and structures).
Rangatahi need differing strategies depending on their developmental stage, symptoms, social situation and available support systems. Some models of care that can assist with this and provide available support and direction and guide appropriate actions can be found in the drop-down headings at the bottom of this article.9,10,11,12
Managing the appointment with a distressed young person
In a consultation, there are some strategies that might be helpful. See the table for tips on consulting with youth about their mental health.
Table: Youth consulting pointers
| Pointer | Comment |
|---|---|
| Know about HEEADSSS – a psychosocial assessment tool identifying risk and protective factors in young people |
Helpful for checking in with how things are going; use as a discussion (not a tick box exercise) to get an overview of what is going on, and to identify the young person’s support people. It can help you understand context and prioritise areas of concern. Remember you don’t have to fix everything – sometimes talking with a young person and giving reassurance can be a helpful strategy |
| Use self-ratings; try a 1–10 scale | It can be useful to ask the young person: “Where are you on a 1–10 scale most days, with 10 being feeling really great and 1 being feeling pretty bad?” With other prompts such as “what makes it worse or moves you towards a 1?” And “what helps you move towards a 10?” |
| Build trust and gather supplementary knowledge from whānau; they may disclose other useful information |
Tell the young person about your concerns: “I’m a bit worried about you. Who is someone in your family that I can talk to, such as an aunty, friend, parent, teacher? |
| Provide follow-up and support upon disclosure | If something is disclosed, it’s important that you can provide timely follow-up and support. Health improvement practitioners (HIPs) and health coaches are useful in this situation and can usually see the young person frequently. Where possible, support a “soft handover” rather than making a cold referral – just sending off a referral is less likely to engage young people. Follow up after a referral appointment to ensure they attended and that they feel their needs are being met |
| Be aware of your own “fear of disclosure” – ensure you know (in advance) how to respond to keep you and the patient safe |
Don’t feel like everything has to be fixed right now. Ask the young person: “Who can I call now to support you?” |
| Create your own plan for managing these situations. Enquire if your practice or PHO/locality has a youth health voice or champion to help promote and deliver funded services |
Find out what resources/agencies are available in your area. These can include providers of face-to-face services such as school-based health teams, youth one-stop shops, iwi providers, Whānau Ora, Child and Adolescent Mental Health Services (CAMHS), or services accessed online and via phone and text (eg, Headstrong, Aunty Dee, Youthline, 1737 or Healthline) |
Provided by Professor Clark (Ngāpuhi), Cure Kids Chair in Child and Adolescent Mental Health at the University of Auckland Waipapa Taumata Rau, in the School of Nursing, Faculty of Medical and Health Sciences.
A brief behavioural screening questionnaire that might be useful for children and adolescents (four to 17-year-olds) is the Strengths and Difficulties Questionnaire (SDQ). This is a validated tool that takes about five to 10 minutes to administer, and there is a self-report version for 11 to 17-year-olds. The tool comprises three to four components, depending on the version used, including:13
- 25 items on psychological attributes divided between five scales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behaviour
- an impact supplement
- cross informant information
- follow-up questions.
Sometimes whānau can find these screening tools confronting and uncomfortable, so ensure they are done within the context of a trusting relationship. BPACnz has published a useful two-article series on addressing mental health and wellbeing in young people.14,15 Your local HealthPathways is also available for information and advice.
Psychological therapies
Non-medicine approaches, including cognitive behavioural therapy (CBT) and other psychological therapies, are recommended as the first choice for supporting youth/rangatahi presenting with mild to moderate symptoms of depression.8 Try to engage a broad approach.
- Use Whānau Ora approaches that help address whānau aspirations and facilitate whānau wellbeing. Identify Māori providers and community organisations that can support families going through tough times.
- Identify current support systems. Who in their whānau or wider support system can help? Find a key caring adult (ie, a grandparent, cousin, aunty) who they trust and who can provide them with wrap-around support.
- If they are at school, who are their supports there? Are they engaged with school-based health services? Helping young people to continue school, university, training or work is key to managing their mental health.
- In mild to moderate depression, CBT alone is recommended when young people are motivated to engage in treatment.16,17
- CBT is less effective where there are high levels of family conflict, or in complex presentations, eg, young people with a history of sexual abuse.16 This is when social work and youth work support might be more useful (ie, to sort out housing and food insecurity, family violence, and care and protection concerns).
- Computerised CBT packages are very promising and can produce equivalent results to face-to-face therapy, certainly in the short term.16
- Several other psychological therapies (interpersonal psychotherapy for depressed adolescents, family therapy and psychodynamic psychotherapy) may have approximately equivalent outcomes to CBT.18
It is important that you have a list of personnel/services you can call on immediately so that the young person receives timely support and then active follow-up. Do you currently have these services available to you if you need them tomorrow?
Addressing the taiao/iwi katoa
Given the dire need for accessible and timely treatments, several mobile health technologies and tools have been developed. Many of these support interventions such as safety planning and skills-based coping approaches. See the panel for some online tools available to support youth mental health.
Online tools available for supporting youth mental health in New Zealand
The Lowdown – a resource designed specifically for young people, offering a range of mental health resources, including articles, videos and interactive tools.
SPARX – a game-based CBT program which uses a range of techniques, including mindfulness, relaxation and cognitive restructuring, to help young people develop coping skills and improve their mental health.
Melon Health – a platform that offers a range of mental health and wellbeing resources, including self-assessments, goal-setting tools, and support groups.
Whanaungatanga resources for rangatahi Māori – a resource for rangatahi Māori (workbook style) that help them identify key things that help them thrive. There is also a resource for whānau who want to understand how they can support their tamariki. These are available in te reo Māori and te reo Pākehā.
Headstrong – an app designed specifically to support rangatahi mental health and resilience. Following predefined rules and scripts, the app delivers content in a way that resembles instant chat and mimics a short conversational exchange.
Whitu – 7 Ways in 7 Days – a bilingual (English and te reo Māori) app designed to be culturally appealing to Māori and Pacific young people. Free to download from Apple and Google Play.
Go to Healthify to view their Clinicians guide: how to choose a health app.
What about antidepressants?
Because depressive disorders exist on a continuum,17 there is inevitable overlap of presentations that are considered ‘mild–moderate’ and ‘moderate–severe’, despite attempts to categorise severity into just one box.
Depression treatment recommendations are based on condition severity, and there are differences depending on where the distinction of ‘moderate’ depression lies – some guidelines use mild and moderate–severe categories, whereas others use mild–moderate and severe categories.
In general, psychological therapy is considered the gold standard treatment for mild to moderate depression if the young person is able/willing to engage; antidepressants are not recommended.16 In youth with severe depression, an antidepressant, alone or in combination with psychological therapy, is recommended.16
However, some young people with moderate depression may not respond to psychological interventions at all, or not until the effect of an antidepressant is evident.17 It is also worth noting that treatment response is faster with an antidepressant than it is with psychological therapies.17 There is a place, therefore, for the pharmacological treatment of "moderate" depression.
Whichever guidance is followed, when initiating antidepressants in youth, the lowest recommended dose should be used to reduce the risk of adverse effects, and treatment reviewed early and regularly.8 Key information about the antidepressant must be identified and discussed with the patient and/or caregiver.
Safety and efficacy data for antidepressant use in young people are not well established and patients should be closely monitored for suicidal thoughts, hostility, agitation or unusual behaviour change.17,19
Antidepressants are not registered for use in people aged under 18; shared decision-making and obtaining informed consent is especially important if prescribing a medicine off-label. Fluoxetine is the only antidepressant shown to have a favourable risk benefit profile in this age group.19 Discussion with a child and adolescent psychiatrist or a paediatrician would be advised if considering prescribing an antidepressant for a person under 18.19
Lasting benefits
Improving care for youth who experience mental health concerns may have long-lasting effects. Employing culturally informed and developmentally appropriate models of care can help achieve equitable mental health outcomes for rangatahi Māori. Furthermore, building young people’s capabilities, resilience and communication skills provides them with resources to take into adulthood and parenthood, leading to benefits across their life course and influencing that of the next generation.20
Back to the scenario
The distressed 16-year-old who presented with a whānau member expecting an antidepressant prescription urgently saw a youth support worker. The young person identified a person they trusted to tautoko/support them and was given tools to assist them during a difficult time. The Māori youth support worker supported them to find safe and secure housing and helped them to get back into their catering course. They also had a keen interest in waka ama, and the youth worker helped link them to a team. The young person and a whānau member were reviewed early and then as often as needed with accessible, culturally safe services. They did not carry with them a diagnostic label and any stigma. They learned how to manage their distress, re-engaged in education and sports, and utilised their support systems. This has important implications for their future wellbeing; further, their occupational and insurance prospects were not influenced by this period of distress.
Models of care
Whānau Ora Outcomes Framework
Whānau Ora is a holistic approach to improving the wellbeing of whānau as a group, and addressing individual needs within the context of whānau.9
Whānau Ora aims include:9
- building whānau capability for self-management, independence and autonomy
- focusing on whānau needs, with integrated and accessible services
- building trusting relationships with service providers and government agencies
- developing a culturally competent and technically skilled workforce
- supporting funding, contracting and policy arrangements.
The Whānau Ora Outcomes Framework is achieved when whānau are:9
- self-managing
- living healthy lifestyles
- participating fully in society
- confidently participating in te ao Māori
- economically secure and successfully involved in wealth creation
- cohesive, resilient, nurturing and responsible stewards of their natural and living environments.
Meihana Model
The Meihana Model requires healthcare professionals to become familiar with cultural practices for Māori and their whānau, to create positive relationships. It encourages understanding of the broad factors that may influence a person’s wellbeing, including those relating to beliefs, values and experiences.10
The key core values and concepts are:10
- whānau – family health
- tinana – physical wellbeing
- hinengaro – mental health
- wairua – spiritual health/attachment
- taiao – physical environment
- iwi katoa – societal structures.
Te Tumu Waiora
Te Tumu Waiora provides rapid, targeted brief interventions to any person experiencing mental distress or needing behavioural advice and support. It evolved in 2013 in Tāmaki Makaurau and was formally piloted and externally evaluated in 2017/18.11,21
Accessed through general practice, the programme integrates three new roles into GP teams:11
- health improvement practitioner (HIP)
- health coach
- NGO support worker.
HIPs and health coaches provide advice and support to people based on individualised goals, promoting self-management and connecting people to other services they may need. HIPs and health coaches both work closely with local community NGO support workers. For some people the initial session is enough to provide the required emotional or behavioural support.10,11
The pilot evaluation showed substantially increased access to these wellbeing supports, positive outcomes and good patient experience. As a result, in the Wellbeing Budget 2019, the Government announced funding to roll this model out to general practice clinics across New Zealand by June 2023. There are some practices that have/are modifying the model of care to tailor it to the cultural needs of their communities and improve access. After making funding available, the Ministry of Health named this programme the Integrated Primary Mental Health and Addiction (IPMHA) service.21
Access and Choice programme
Access and Choice is a government-funded programme providing generally free services for people with mild to moderate mental health and addiction needs. The programme is undergoing a five-year phased rollout period from 2019 to 2024. Its intention is to alter how services are delivered and provide services and supports to anyone who needs them, at the time of need, in a range of settings: kaupapa Māori, Pacific, and youth settings, as well as in general practice and other community settings.12
Access to services is available for as long as required. Services funded are:12
- IPMHA services – provided in general practices and accessible to people enrolled in those practices
- kaupapa Māori services – whānau-centred services delivered by Māori for Māori
- Pacific services – led by Pacific peoples incorporating their values, beliefs, languages and models of care
- youth services – flexible services delivered in spaces acceptable and accessible to youth.
Content updates
26 July 2023: Whitu - 7 Ways in 7 Days and a link to the Healthify clinicians' guide to choosing a health App added to Online tools box.
References (for online article)
- Fleming T, Tiatia-Seath J, Peiris-John R, et al. Youth19 Rangatahi Smart Survey, initial findings: Hauora hinengaro/emotional and mental health. 2020. The Youth19 Research Group, The University of Auckland and Victoria University of Wellington, New Zealand.
- Sutcliffe K, Ball J, Clark TC, et al. Rapid and unequal decline in adolescent mental health and well-being 2012–2019: Findings from New Zealand cross-sectional surveys. Australian & New Zealand Journal of Psychiatry 2023;57(2):264–282.
- Clark TC, Ball J, Fenaughty J, et al. Indigenous adolescent health in Aotearoa New Zealand: Trends, policy and advancing equity for rangatahi Maori, 2001–2019. The Lancet Regional Health-Western Pacific. 2022;28:100554.
- Fleming T, Ball J, Bavin L. et al. Mixed progress in adolescent health and wellbeing in Aotearoa New Zealand 2001–2019: a population overview from the Youth2000 survey series. J R Soc NZ 2022;52:426–49.
- New Zealand Mental Health and Wellbeing Commission. Te Huringa: Change and Transformation. Mental Health Service and Addiction Service Monitoring Report 2022. Wellington, New Zealand. https://www.mhwc.govt.nz/assets/Te-Huringa/FINAL-MHWC-Te-Huringa-Service-Monitoring-Report.pdf
- He Ako Hiringa. EPiC dashboard: Youth Mental Health. https://epic.akohiringa.co.nz (accessed March 2023). Data sourced from Te Whatu Ora, Pharmaceutical claims collection, 2023.
- Te Hiringa Mahara – the Mental Health and Wellbeing Commission. Young people speak out about wellbeing: An insights report into the wellbeing of rangatahi Māori and other young people in Aotearoa. 2022. Wellington, New Zealand. https://www.mhwc.govt.nz/assets/Youth-wellbeing-/Youth-Wellbeing-Insights-Report-Full.pdf
- Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry. 13th edition. Wiley-Blackwell. July 2018.
- Te Puni Kōkiri. The Whānau Ora outcomes framework. July 2016. https://www.tpk.govt.nz/docs/tpk-wo-outcomesframework-aug2016.pdf (accessed May 2023).
- Wilson D, Moloney E, Parr J, et al. Creating an indigenous Māori-centred model of relational health: A literature review of Māori models of health. J Clin Nurs 2021;30:3539–55.
- Te Tumu Waiora. https://tinyurl.com/mrx9ynz3 (accessed May 2023).
- Access and Choice. https://www.wellbeingsupport.health.nz (accessed May 2023).
- Australian Mental Health Outcomes and Classification Network. Strengths and Difficulties Questionnaire. https://www.amhocn.org/sites/default/files/publication_files/sdq_manual_0.pdf (accessed May 2023).
- BPACnz. Addressing mental health and wellbeing in young people. 2015. https://bpac.org.nz/BPJ/2015/October/wellbeing.aspx (accessed May 2023).
- BPACnz. Managing frequently encountered mental health problems in young people: Non-pharmacological strategies. 2015. https://bpac.org.nz/BPJ/2015/December/mental-health.aspx (accessed May 2023).
- Whāraurau. Evidence based intervention: Depressive Disorders. https://wharaurau.org.nz/resources/publications/depressive-disorders (accessed May 2023).
- Malhi GS, Bell E, Bassett D, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust NZ J Psychiatry 2021;55:7–117.
- National Institutes for Health and Care Excellence (NICE). Depression in children and young people: identification and management. NICE guideline [NG134] 2019. https://www.nice.org.uk/guidance/ng134 (accessed May 2023).
- New Zealand Formulary for Children. Antidepressant drugs. https://www.nzfchildren.org.nz/nzfc_2225 (accessed May 2023).
- Patton GC, Sawyer SM, Santelli JS, et al. Our Future: A Lancet Commission on Adolescent Health and Wellbeing. Lancet. 2016;387(10036):2423–2478.
- Codyre D, Cribb-Su’a A, Todd D. How to Treat: Te Tumu Waiora – three years on. New Zealand Doctor. 15 February 2023 (accessed May 2023).
References (for Pharmacy Today article)
- Fleming T, Tiatia-Seath J, Peiris-John R, et al. Youth19 Rangatahi Smart Survey, initial findings: Hauora hinengaro/emotional and mental health. 2020. The Youth19 Research Group, The University of Auckland and Victoria University of Wellington, New Zealand.
- Sutcliffe K, Ball J, Clark TC, et al. Rapid and unequal decline in adolescent mental health and well-being 2012–2019: Findings from New Zealand cross-sectional surveys. Australian & New Zealand Journal of Psychiatry 2023;57(2):264–282.
- Clark TC, Ball J, Fenaughty J, et al. Indigenous adolescent health in Aotearoa New Zealand: Trends, policy and advancing equity for rangatahi Maori, 2001–2019. The Lancet Regional Health-Western Pacific. 2022;28:100554.
- Fleming T, Ball J, Bavin L. et al. Mixed progress in adolescent health and wellbeing in Aotearoa New Zealand 2001–2019: a population overview from the Youth2000 survey series. J R Soc NZ 2022;52:426–49.
- New Zealand Mental Health and Wellbeing Commission. Te Huringa: Change and Transformation. Mental Health Service and Addiction Service Monitoring Report 2022. Wellington, New Zealand. https://www.mhwc.govt.nz/assets/Te-Huringa/FINAL-MHWC-Te-Huringa-Service-Monitoring-Report.pdf
- He Ako Hiringa. EPiC dashboard: Youth Mental Health. https://epic.akohiringa.co.nz (accessed March 2023). Data sourced from Te Whatu Ora, Pharmaceutical claims collection, 2023.
- Te Hiringa Mahara – the Mental Health and Wellbeing Commission. Young people speak out about wellbeing: An insights report into the wellbeing of rangatahi Māori and other young people in Aotearoa. 2022. Wellington, New Zealand. https://www.mhwc.govt.nz/assets/Youth-wellbeing-/Youth-Wellbeing-Insights-Report-Full.pdf
- Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry. 13th edition. Wiley-Blackwell. July 2018.
- Te Puni Kōkiri. The Whānau Ora outcomes framework. July 2016. https://www.tpk.govt.nz/docs/tpk-wo-outcomesframework-aug2016.pdf (accessed May 2023).
- Wilson D, Moloney E, Parr J, et al. Creating an indigenous Māori-centred model of relational health: A literature review of Māori models of health. J Clin Nurs 2021;30:3539–55.
- Te Tumu Waiora. https://tinyurl.com/mrx9ynz3 (accessed May 2023).
- Access and Choice. https://www.wellbeingsupport.health.nz (accessed May 2023).
- BPACnz. Addressing mental health and wellbeing in young people. 2015. https://bpac.org.nz/BPJ/2015/October/wellbeing.aspx (accessed May 2023).
- BPACnz. Managing frequently encountered mental health problems in young people: Non-pharmacological strategies. 2015. https://bpac.org.nz/BPJ/2015/December/mental-health.aspx (accessed May 2023).
- Whāraurau. Evidence based intervention: Depressive Disorders. https://wharaurau.org.nz/resources/publications/depressive-disorders (accessed May 2023).
- Malhi GS, Bell E, Bassett D, et al. The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust NZ J Psychiatry 2021;55:7–117.
- National Institutes for Health and Care Excellence (NICE). Depression in children and young people: identification and management. NICE guideline [NG134] 2019. https://www.nice.org.uk/guidance/ng134 (accessed May 2023).
- New Zealand Formulary for Children. Antidepressant drugs. https://www.nzfchildren.org.nz/nzfc_2225 (accessed May 2023).
- Patton GC, Sawyer SM, Santelli JS, et al. Our Future: A Lancet Commission on Adolescent Health and Wellbeing. Lancet. 2016;387(10036):2423–2478.
- Codyre D, Cribb-Su’a A, Todd D. How to Treat: Te Tumu Waiora – three years on. New Zealand Doctor. 15 February 2023 (accessed May 2023).
Acknowledgements
Dr Neil Whittaker, Specialist General Practitioner, Golden Bay Community Health Centre.
Professor Terryann Clark (Ngāpuhi), Cure Kids Chair in Child and Adolescent Mental Health at the University of Auckland Waipapa Taumata Rau, in the School of Nursing, Faculty of Medical and Health Sciences.
Gayle Robins, freelance medical writer and regular contributor to He Ako Hiringa resources.
Professional college endorsements
This activity has been endorsed by The Royal New Zealand College of General Practitioners (RNZCGP) and has been approved for up to 0.25 CME credits for continuing professional development purposes (1 credit per learning hour). To claim your CPD credits, log in to your Te Whanake dashboard and record these activities under the appropriate learning category.
This activity has been endorsed by the PSNZ as suitable for inclusion in a pharmacist’s CE records for CPD purposes.
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