Young people with complex psychosocial or physical problems may require the support of a number of different services and sectors. This may involve referral to specialists and the establishment of a multidisciplinary team.⁹ 

It is essential to identify all these different services and sectors and to ensure that there is a consistent and co-ordinated response that has at its centre the young person and his/her needs. 

General practice settings are in a unique position within the primary health care system to coordinate the multidisciplinary care that a young person with complex needs may require. For a student with complex support needs, the school also will be integrally involved with ongoing care and support. This means that the roles of the staff within the school need to be determined in terms of their responsibilities within the multidisciplinary team. A clear understanding of the roles and responsibilities of all the parties must be established. These roles and responsibilities will vary depending on the needs of the student, the types of resources available in the community, and the types of supports and services that the student needs to access.

Many partnerships within the MindMatters Plus GP initiative begun by mapping the local services available to support young people. This was a more complex task than it appears as the list of potentially relevant services is large and diverse, and there must also be a supportive environment for the referral process.

Referral pathways

A referral pathway is a series of steps, including clinical interventions, to be taken by schools and local health providers in response to young people with high mental health support needs. A referral pathway is a process as much as a product or tool. Ideally it is developed via a comprehensive and inclusive approach between the school and relevant health agencies to establish relationships and a shared understanding and agreed ways of working together to better address the mental health needs of young people. Resource 14: Key elements of a referral pathway  shows some of the key elements required for effective referral pathways.

Some of the services that may be involved in referrals for provision of care to young people are listed in Resource 15: Mapping local services that support young people . For each of these types of services, it is useful to determine whether they are available locally (and if not how are these types of services delivered in the community), the name of the service, contact details, and also the referral processes they use. [Note that undertaking this mapping process can also help establish where the service gaps are within your community].

It is especially important to be able to clearly determine the target groups of each of these services and their referral process. Most services have specific entry criteria and access processes. Understanding these boundaries and processes is essential to being able to access the appropriate services quickly and effectively.

Tip: A mapping exercise of community health and support services can be time consuming for an individual teacher or group of teachers. However, for a senior class in subjects such as health, psychology, English, or community studies, developing such a resource can be a valuable learning experience. Students can help to develop the resource map while also learning about their local services and gaining important research skills.

A useful resource is the Who is our community? audit tool and mapping database available through Community Matters at:
/_assets/http/cms.curriculum.edu.au/mindmatters/resources/docs/comm_matters/audit.doc
/_assets/http/cms.curriculum.edu.au/mindmatters/resources/docs/comm_matters/database.doc