UN International Youth Day 2014 – Mental Health Matters by Professor Patrick McGorry
This year UN International Youth Day is recognising an issue that has remained inexplicably hidden until recently – an issue that has profound implications for the health, wellbeing and productivity of our planet.
Mental ill health is the number one health issue facing young people worldwide. As the leading cause of disability in those aged between 10 and 24 years, it contributes 45% of the overall burden of disease in this age group. Further complicating this picture is the timing of onset of the major adult-type mental illnesses: 75% of people suffering from a psychiatric disorder experience their first episode by 24 years of age. Because this is the phase of life when young people are making the transition from childhood to independent adulthood—finishing their education, beginning their working lives, leaving their families of origin and establishing intimate relationships of their own, it is hardly surprising that mental illness, even when brief and relatively mild, and especially when more severe and persistent, can seriously disrupt this normal developmental trajectory and limit a young person’s potential.
There is a powerful case for transformational reform of our current mental health services to accommodate and indeed give pride of place to our young people. Despite their manifest need, young people have the lowest rates of access to mental health care, largely as a result of poor awareness and help-seeking, the structural and cultural flaws in our existing care systems, and a serious failure by society to recognise the importance of this issue and invest in youth mental health. Our primary health care system is geared to physical health care, and since young people are usually in good physical health, they may not visit health practitioners often. When they do, they often find it extremely difficult to mention emotional concerns. Issues of access, cost, and confidentiality may also be significant barriers to care.
Of even more concern is the fact that when young people and their families do seek help for mental health concerns, they have great difficulty in accessing care, since the complex and evolving symptom profiles that young people typically experience in the early stages of a mental illness often do not meet the stringent criteria required for acceptance into the existing services. This is because our current child and adolescent mental health services have evolved from an initial focus on the needs of younger children, and therefore are inappropriate for older adolescents, especially those with more severe disorders; while our adult services have been designed to meet the needs of older adults with chronic mental illness. Thus, our care system is weakest where it should be strongest, and young people who are struggling with mental health issues all too often fall through the cracks.
Encouragingly, there is now a growing recognition of the importance of young people’s mental health issues, and this has led to service reforms in several countries now. In 2006 the Australian Federal Government led the way with the establishment of headspace, our national youth mental health system, which is now operating in over 70 sites across the nation, with a further 30 centres to be set up by 2017. headspace offers multidisciplinary care in the four core streams particularly relevant to young people: mental health, drug and alcohol services, physical health and vocational/educational assistance, with close links to local specialist services, schools and other community-based organisations. Each headspace centre also runs awareness campaigns to enhance the ability of young people and those who live and work closely with them to recognise mental health concerns, and how and where to seek help when necessary. In addition to these face-to-face services, headspace also operates a nationwide online support service (eheadspace); where young people can ‘chat’ with a mental health professional either online or by telephone and access assessment and therapeutic care.
This initiative has significantly expanded access to expert mental health care for many young Australians, offering care when, where and how they choose to use it. Young people now have free access to early intervention and evidence-informed, stigma-free care, and they and their families are voting with their feet, with the demand for these services growing steadily. The long-term aim of these reforms is to develop a nationwide youth mental health stream that fully integrates care for young people, in order to provide seamless care from puberty to mature adulthood at around 25 years of age, with soft transitions with child and adult mental health care. This system acknowledges biopsychosocial development and recognises the complexity and challenges faced by young people as they become independent adults, as well the burden of disease imposed on this age group by mental ill-health.
These approaches, which offer holistic care from the outset, contrast with the currently accepted status quo, which all too often and for various reasons, involves outright neglect. Care systems such as these that offer easy access, early recognition and early intervention with a pre-emptive focus have the greatest potential to dramatically improve the mental health, wellbeing, productivity and fulfilment of young people, and our wider society, right now and well into the future.
Professor Patrick McGorry MD, PhD, FRCP, FRANZCP is the Executive Director of Orygen Youth Health Research Centre