Children’s and younger persons health
Priority Area
Health Needs Assessment 2025 - 2028
The foundations of early childhood development are critical in shaping long-term health and wellbeing. Children on the North Coast face considerable developmental vulnerabilities, particularly in areas such as physical health and wellbeing, social competence and mental health (AEDC, 2024). These vulnerabilities are compounded by limited access to timely and appropriate mental health services, especially in the local government areas (LGAs) of Nambucca Valley, Clarence Valley and Kempsey. Community consultations revealed that while larger centres such as Coffs Harbour are relatively well-served, many smaller areas struggle to provide consistent mental health support for young people.
The early development of children in Australia is assessed across 5 domains: 1) physical health and wellbeing, 2) social competence, 3) emotional maturity, 4) language and cognitive skills (school-based) and 5) communication skills and general knowledge. From 2018 to 2021 on the North Coast there was an increase in the proportion of children assessed as vulnerable in each of the 5 early development domains.
Across the North Coast region, 22% of children in their first year of school are vulnerable on 1 or more domains and 12% are vulnerable on 2 or more domains. These children may have compounded developmental difficulties and be at higher risk of poorer health and wellbeing (AEDC, 2024). The North Coast LGAs with the highest levels of vulnerability for socio-economic determinants of health have the highest rates of vulnerable children in their first year of school, notably Kyogle, Richmond Valley, Kempsey and Nambucca Valley (AEDC, 2024; Australian Bureau of Statistics, 2021).
The importance of early intervention and availability of quality support services for the development of children and young people was reported during community consultations. This is particularly important for children with health conditions and developmental challenges and delays. Many consultation participants reported that the lack of services to provide support in the early years is having substantial negative effects on children’s development.
Improving access to mental health services, including in-school mental health support, and addressing the service gaps in regional and rural areas could help mitigate the growing vulnerability of children on the North Coast. Community feedback indicates that schools are often expected to manage mental health issues without the proper training or resources. A more integrated approach to mental health support within schools could improve developmental outcomes for children, especially those in vulnerable situations.
The Australian national immunisation target is 95% and aims to protect the population against major infectious diseases for which vaccines are available. The full immunisation rate includes children vaccinated against hepatitis B, diphtheria, tetanus, pertussis, haemophilus influenzae type b, polio, measles, mumps, rubella, pneumococcal, varicella and meningococcal C.
In 2023, fewer children on the North Coast aged 1-year, 2-years and 5-years were fully immunised compared to immunisation rates in NSW or Australia. Children in the Byron LGA are the least likely to be fully immunised on the North Coast, with a gap in the 3 age groups greater than 20% to children nationally. Children in Bellingen, Kyogle and Tweed LGAs have some of the lowest full immunisation in the region (Social Health Atlas of Australia, 2021). This highlights the need for targeted efforts to improve immunisation coverage, particularly in regions with lower full immunisation, to ensure better protection against preventable diseases and prevent potential outbreaks.
Figure 1 The full immunisation rates for children aged 1-year, 2-years and 5-years are lower on the North Coast than Australia wide.
Source: Social Health Atlas of Australia, 2021
Healthy habits formed in childhood, such as eating well, being active and getting enough sleep can set up the foundations for better health in adulthood (Lioret, et al., 2020).
- Children on the North Coast engage in higher levels of physical activity than the NSW average. In 2022-23, children in both the Mid North Coast Local Health District (LHD) (28%)and in Northern NSW LHD (38%) met the Australian physical activity guidelines more than children (20%) in NSW
- It is recommended that children do not engage in more than 2 hours of sedentary behaviour or screen time (outside of school-based hours) per day. More than half the children aged 5-15 years in both LHD areas exceeded this in 2022-23. This was less than the number of children in NSW.
- Children aged 2-15 years’ fruit and vegetable consumption varies across LHD areas on the North Coast. Fewer children in the Mid North Coast LHD area met the recommended servings of fruit (54%) and vegetables (5%) than those in the Northern NSW LHD area (65% for fruit and 7% for vegetables). The statewide average (58% for fruit and 5% for vegetables). Consumption of vegetables remains very low across all ages (NSW Government, 2024).
While these figures show some positive behaviours, there are opportunities to support initiatives that increase physical activity, boost fruit and vegetable consumption and reduce children’s screen time and sedentary behaviour. Programs addressing these could help improve healthy eating and physical activity, which are key to improving health outcomes and fostering healthier communities. In the long-term, these initiatives could reduce chronic disease and enhance overall quality of life.
Young people’s mental health and wellbeing remains a challenge across the North Coast region.
More young people experience mental health conditions, including depression and anxiety, and engage in self-harm and suicide attempts, on the North Coast than NSW (AIHW, 2024). Concerns about access to appropriate and timely mental health services for children and young people, particularly but not limited to the more regional areas, were raised extensively in consultations with community members, service providers and subject matter experts.
Mental health service providers and subject matter experts highlighted that younger girls are increasingly experiencing anxiety and school refusal, and older girls are increasingly engaging in suicidal behaviours. This concerning evidence is part of a broader trend of increasing intentional self-harm hospitalisations and increasing numbers of young people dying by suicide (AIHW, 2024) They raised concerns about the continued gap in access to both clinical and non-clinical mental health services for young people. They indicated that where creative therapies exist, there is high uptake.
As part of the Targeted Regional Initiatives for Suicide Prevention (TRISP) Healthy North Coast conducted consultations in Port Macquarie, Grafton, Coffs Harbour, Lismore, Tweed Heads and online in August 2024. One of the 4 lifespan strategies explored was: Promoting help-seeking, mental health and resilience in schools. The TRISP participants reported technology limitations involved in receiving support and fear around help-seeking as access barriers for young people. They raised factors affecting students’ psychological health need recognition, and there is a need for more mental health education in the school curriculum. These were also identified in the service provider and subject matter expert consultations as part of this needs assessment.
Early intervention is critical to manage the early symptoms of poor mental health to minimise deterioration and progression to more severe or acute illness. Consultation participants highlighted that many mental health challenges are exacerbated by a lack of emotional coping strategies, contributing to issues like substance use and suicidality. Since emotional regulation difficulties are linked to self-harm, substance abuse and suicidal behaviour, incorporating programs to teach these skills in schools and in communities could provide vital early intervention before mental health issues become more severe.
More young people on the North Coast region are accessing mental health services commissioned by Healthy North Coast. In 2023-24, of all people who attended these services, 23% were people aged up to 24 years old. This has increased by 13% in the 3 years since 2020-21. Of all care provided to young people in 2023-24, 17% was coded as ‘child and youth specific’ and the remaining was for other services, such as psychological therapies, low-intensity treatments or services for Aboriginal communities. Generalised anxiety was the most diagnosed condition in young people, followed by post-traumatic stress disorder (PTSD). Both diagnoses increased from 2020-21. Notably, between 2021-21 and 2023-24 the number of young people diagnosed with attention-deficit/hyperactivity disorder (ADHD) doubled on the North Coast (PMHC MDS, 2024).
The increase in mental health concerns, particularly anxiety, PTSD and ADHD among young people, highlights a growing demand for mental health services tailored to youth and families. There is a need for expanded mental health resources, early intervention strategies and services that are specifically designed to address the unique needs of younger people and those supporting them. Without improved accessibility to primary care mental health services, the challenges faced by young people in the region may continue to escalate, placing greater strain on existing mental health services.
There are considerable barriers to accessing adequate and consistent health care for children, particularly for families living in regional and rural areas. Many families with children reported via the survey and community consultations that they experience long wait times for specialist care and the need to travel long distances to access services.
The shortage of psychiatrists, paediatricians, speech therapists and other health professionals was identified as a contributing factor to poor access and support for health conditions. This was particularly concerning for families of children with neurodivergent conditions like attention-deficit/hyperactivity disorder (ADHD), health conditions and developmental challenges and delays where timely support is crucial. Psychiatry services are often unavailable locally and there are long wait times for outreach services, often conducted through telehealth. Many consultation participants felt telehealth was not appropriate for young children. Parents and child educators felt strongly that telehealth is not an appropriate way to assess and manage young children’s health. This points to a need for more localised and timely health services and a shift towards more in-person consultations for children, where appropriate.
Throughout this document ‘survey’ refers to the 2024 Better Health Community survey undertaken as part of the Health Needs Assessment 2025-28 consultation process.
