Volume 188 - Issue 8
Early intervention in youth mental health
Authors: Patrick D McGorry, Ian B Hickie, Anthony F Jorm and Rosemary Purcell
Med J Aust 2008; 188 (8): 492-493. || doi: 10.5694/j.1326-5377.2008.tb01735.x
Published online: 21 April 2008
Published online: 21 April 2008
In reply: Sholl asserts that our case for reform of youth mental health services is based largely on personal opinion. In fact, as detailed in the Journal supplement,1 it is based on hard epidemiological facts, the latest developmental perspectives and a growing evidence base. Consequently, it has been widely supported by young people, families, governments and the community.
The youth model ensures that developmental approaches appropriate to all stages of the process of transition from childhood to adulthood continue until the young person is genuinely independent. To design a health system around the transition age of 18 years, based on legal and educational precedents, is outmoded. Many more young people now pursue postsecondary education and are financially and socially dependent on their families well into young adulthood.2 The youth mental health paradigm involves families in a developmentally appropriate way from puberty to the mid-20s, and also recognises the increasing value of peer relationships. The key difference is that young people have increasing choice about the level and pattern of family engagement. Similarly, brain development continues actively up until the mid-20s.
We believe Sholl has misunderstood the fundamental issue of youth mental health reform. It is not a binary choice between current child–adolescent and adult service models. A new stream of care is required to respond to these “transition age youth” or “emerging adults”, as they were recently termed.2 This stream borrows many of the features of adolescent psychiatry and extends these to around 25 years of age, complementing them with new evidence-based approaches, which have been difficult to create and nurture within a constrained and under-resourced Child and Adolescent Mental Health Services system. This step is crucial for the “graduates” of state care, who have appalling outcomes when care is withdrawn at 18 years (even though they can vote).3
We have successfully developed and provided such an adolescent–young adult service to a quarter of Melbourne for over a decade. Recently, we extended this to Sydney. The real-world impact of this approach has helped greatly to convince the community, including federal and state government leaders, of its wider value.
We want to see genuine reform, restructure and substantial investment in a new stream of care. How well this links, not only with existing child and adult specialist systems, but equally importantly with other key systems — notably education and employment, primary care, housing, justice and drug and alcohol services — will be critical to its success.
References
- Early intervention in youth mental health. Med J Aust 2007; 187 (7 Suppl): S1-S74. 0_CBBJDDFF
- Graham P. The end of adolescence. Oxford: Oxford University Press, 2004. 0_i1091833
- Osborn A, Bromfield L. Young people leaving care. Research brief no. 7. Melbourne: Australian Institute of Family Studies, 2007. http://www.aifs.gov.au/nch/pubs/brief/rb7/rb7.html (accessed Feb 2008).