Principles of youth participation in mental health services

Anthony M James
Med J Aust 2007; 187 (7): S57. || doi: 10.5694/j.1326-5377.2007.tb01339.x
Published online: 1 October 2007
Participation of young people — why is it different?

Young people’s experience of mental illness and their subsequent treatment needs are often different from those of adults. For young people, the experience of mental illness is often episodic rather than chronic and, as such, they view their time as a consumer of mental health care to be short term rather than longer term. Consequently, they often do not relate or identify with the term “consumer”. Even young people with serious mental illnesses often reject the term “consumer”, preferring to be identified as a “young person” or “youth”.

Although the onset of mental illness is highest in adolescence and early adulthood, young people experience substantial barriers in promptly accessing health care services. Most young people have little previous experience of the health system — particularly the mental health system — and how it is structured. They might not have a general practitioner of their own, or may not think their problems are related to their health or that they could benefit from treatment.2-4 Many are concerned about confidentiality, particularly when they are in a transitional stage of reducing their dependence on their parents. Some find the symptoms of mental illness disturbing, embarrassing or shameful. In addition, the illness itself can interfere with their capacity to seek appropriate care.

In the face of these numerous barriers, it is essential that mental health services are “youth friendly”. Young people have been described as being very discerning about when, where and from whom they seek assistance.5 Mental health services need to provide accessible and non-threatening environments, where health professionals understand the special needs of people who are not only young and “inexperienced” as health consumers, but also in the early stages of illness. Young people are best positioned to judge what is youth-friendly and what is not, whether they feel welcomed by a particular system of care, whether the style and content of education and information works for them, and whether their opinions and wishes are respected.

In return for their contribution to improving services, young people feel valued and listened to, develop confidence and new skills, and feel they have “put something back” into the system that helped them.

Models of participation by young people

The advent of headspace, the National Youth Mental Health Foundation, in July 2006 has highlighted the commitment of the mental health care sector to adolescents and young adults, and the need to seek their continuing participation as services improve and expand (see McGorry et al, "headspace: Australia’s National Youth Mental Health Foundation — where young minds come first"). The resources of headspace include a Youth Services Development Fund to help support the development of more accessible, effective and integrated approaches to service delivery in local communities. The participation of young people, including those who have not been consumers of mental health services, will be central in refining the activities of headspace.

Existing youth participation programs provide an insight into what can be achieved, at both national and local levels. The examples of youth participation given below are leading the way in terms of best practice for involving young people in mental health care services. They demonstrate the range of circumstances in which participation can occur, varying in scope from national to local, and differing markedly in the level of financial support.


Ybblue, the youth program of beyondblue, promotes the central message that “it’s okay to talk about depression” and encourages young people, their families and friends to seek help when it is needed.

Communicating the message depends on meaningful participation by young people, achieved partly through the Ybblue Crew. The Crew, a group of 33 young people aged from 16 to 25 years and living across Australia, works to provide advice on how to recognise depression, how to talk about it, and how to get help. Specific aims include:

The Crew advise on the content and presentation of the Ybblue website (, are active in public speaking and media appearances, write and edit a newsletter (YBInformed), and develop and edit Ybblue materials, such as fact sheets and postcards. Two Ybblue Crew members are on the management committee of blueVoices, the consumer and carer arm of beyondblue.

Ybblue allows young people to make decisions and positive contributions about mental health services, drawing on their unique “lived experience” of mental illness.


Headroom (, developed within the Children, Youth and Women’s Health Service of the Government of South Australia, provides a partnership model of participation for young people aged under 18 years. The project started with two full-time equivalent positions in 1997, although funding has declined since then. Headroom reflects the commitment of the service to working with young people, providing mechanisms to support their participation in mental health care. Involvement of Headroom’s members is facilitated by an Internet chat room, as well as more traditional methods, such as face-to-face meetings and email.

Health promotion and a website are now the focus of Headroom’s activity. Members of the group assist in identifying issues of most concern to young people, develop written information and DVD presentations, provide focus testing, and advise about the look and “feel” of the site. The group also plans and conducts promotional activities, including presentations to funding and health bodies.

Feedback from young people has been very positive:

Platform Team, ORYGEN Youth Health

The philosophy of ORYGEN Youth Health acknowledges that their clients learn much about what has helped and what has not, and that this knowledge can improve the service and help others. The Platform Team is a group of current and past clients who meet regularly, initiating issues for discussion themselves, as well as responding to issues raised by staff and others. There are usually about 10 members of the Platform Team, with varied experiences and backgrounds. The Team operates as a group, in contrast to the individual consumer consultation model often used in adult services, and has considerable autonomy and responsibility in determining its activities.

Other elements of youth participation at ORYGEN include:

A personal account of the experiences of one Platform Team member is given in Box 1.


Enthusiasm about youth participation in mental health services must be matched by adequate resources, a clear understanding of the rights and responsibilities of those who become involved, and a genuine appreciation of the benefits that can flow from seeking input from young consumers. Some of the issues to be considered in expanding the role of youth participation are listed in Box 2.

1 The mental health system through our eyes

By Vittoria Tonin, Platform Team, ORYGEN Youth Health

Many young people battle life with a mental illness, and many remain undiagnosed until their condition becomes acute. In these situations young people are not the only victims, as their friends and families suffer too.

For 10 years I battled depression alone, suffering and confused. Despite unsafe practices like eating disorders and suppressing my emotions, my mental illness went unnoticed. One day it became too much and my life was in jeopardy. Before my first overdose I had told my medical team of my plans to kill myself, but it was the police intervention that led to me being admitted to a child psychiatric ward.

Life as a teenager is very confronting and hard enough to cope with by itself, let alone while carrying the extra burden of mental illness. Often teenagers are unaware of their condition, don’t know where to seek help, don’t want to be treated differently to their peers, or are ashamed of their illness.

Our health system needs to take the next step forward in removing the barriers between health professionals and young people. It needs to start listening to what we are saying and what we are asking for. To know what works best for us, the system has to become youth-friendly and youth-oriented.

Even when youth-specific services are available, many young people don’t know they exist, don’t know how to access them, or fear the repercussions of using them. For us to pick up the phone, to see a professional, and to acknowledge and discuss our problems takes immense courage. Fear of the unknown and the stigma of mental illness stands in the way. Fear of rejection can be enough to prevent young people from asking for help.

Some people think that treatment will cost too much, so they or their families will not be able to afford it. Some live in regional or remote areas far removed from services. No young person should be stripped of their right to access treatment, but financial and geographical inequalities make this happen every day.

For society to develop youth-friendly mental health services, it must learn to listen to young people, do so willingly and frequently, and take notice of what it hears. A company designing a new mobile phone would ask their market what they would like, and then design the product. Mental health care is no different — the more the authorities and the experts listen to young people, the more successful our health care system will be.

Young people deserve to feel safe and comfortable when accessing all types of medical services. We need to be kept informed throughout our treatment, and told about our rights, roles and responsibilities. This will increase the level of control we feel over our own situation and give us the power to participate in our treatment.

Young people are not always willing to comply with recommendations about their treatment, but this happens in all age groups. Look below the surface to find out why. For many young people, treatment can be a frustrating process in which they feel separated, powerless, pressured and left outside “the loop”. Instead, including us in our recovery, for example by carefully discussing the choice of a new medication, will make it more successful and sustainable.

Youth mental health services must understand that they need the opinions and input of their young clients as well as the advice of clinicians, academics and scholars. Neither being young, nor having a mental illness, means our opinions don’t matter, or that our input will not help improve the service and provide better outcomes. People accessing health services should not be disadvantaged by geography, or by their financial status or their socioeconomic rank. Neither should they be disadvantaged by their young age, or their type of illness.

As young people, we are often told we are “the future”. If the health care system thinks the same way, then we will all benefit.

  • Anthony M James

  • Orielton Partnership/CME Australia, Hobart, TAS.



headspace would like to thank the members of the following youth participation programs and organisations who contributed to the development of this manuscript: Ybblue Crew — beyondblue; Platform Team, ORYGEN Youth Health; Headroom, Children, Youth and Women’s Health Service; and the Mental Health Council of Australia.

Competing interests:

I received an honorarium for writing this article.

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  • 2. Booth M, Bernard D, Quine S, et al. Access to health care among NSW adolescents. Sydney: NSW Centre for Advancement of Adolescent Health, The Children’s Hospital at Westmead, 2002.
  • 3. Sawyer MG, Arney FM, Baghurst PA, et al. The mental health of young people in Australia. Child and adolescent component of the National Survey of Mental Health and Well-being. Canberra: Mental Health and Special Programs Branch, Australian Department of Health and Aged Care, 2000.$File/young.pdf (accessed Aug 2007).
  • 4. Youth Affairs Council of South Australia. Getting through: responding to young people’s mental health issues in the youth sector. Adelaide: YACSA, 2006.
  • 5. Deane FP, Wilson CJ, Ciarrochi J, Rickwood D. Mental health seeking in young people. Report for the National Health and Medical Research Council of Australia. Grant YS060. Wollongong, NSW: University of Wollongong, Illawarra Institute for Mental Health, 2002.


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