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Right care, first time: a highly personalised and measurement-based care model to manage youth mental health

Ian B Hickie, Elizabeth M Scott, Shane P Cross, Frank Iorfino, Tracey A Davenport, Adam J Guastella, Sharon L Naismith, Joanne S Carpenter, Cathrin Rohleder, Jacob J Crouse and Daniel F Hermens
Med J Aust 2019; 211 (9): S1-S46. || doi: 10.5694/mja2.50383
Published online: 4 November 2019

Summary

  • Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change. Consequently, the effects of adolescent-onset mood and psychotic syndromes can have long term consequences.
  • A key clinical challenge for youth mental health is to develop and test new systems that align with current evidence for comorbid presentations and underlying neurobiology, and are useful for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care.
  • Our highly personalised and measurement-based care model includes three core concepts:
    • A multidimensional assessment and outcomes framework that includes: social and occupational function; self-harm, suicidal thoughts and behaviour; alcohol or other substance misuse; physical health; and illness trajectory.
    • Clinical stage.
    • Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on proposed pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian).
  • The model explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within this highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care as well as utilisation of multidisciplinary teams of health professionals.
  • Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality, mental health care for young people.

For the full Supplement, download the PDF or visit Wiley Online Library.

Provenance: Commissioned; externally peer reviewed.

View this article on Wiley Online Library
  • Ian B Hickie1
  • Elizabeth M Scott1,2
  • Shane P Cross1
  • Frank Iorfino1
  • Tracey A Davenport1
  • Adam J Guastella1
  • Sharon L Naismith1
  • Joanne S Carpenter1
  • Cathrin Rohleder1
  • Jacob J Crouse1
  • Daniel F Hermens1,3

  • 1 Brain and Mind Centre, University of Sydney, Sydney, NSW.
  • 2 University of Notre Dame Australia, Sydney, NSW.
  • 3 Sunshine Coast Mind and Neuroscience – Thompson Institute, University of the Sunshine Coast, Birtinya, QLD.


Correspondence: ian.hickie@sydney.edu.au

Collaborating authors: Joanne S Carpenter,Shane P Cross, Jacob J Crouse, Tracey A Davenport, Adam J Guastella, Ian B Hickie,Frank Iorfino,Dagmar Koethe,F Markus Leweke, Sharon L Naismith,Cathrin Rohleder,Ashleigh M Tickell (Brain and Mind Centre, University of Sydney, Sydney, NSW); Daniel F Hermens (Brain and Mind Centre, University of Sydney, Sydney, NSW, and Sunshine Coast Mind and Neuroscience – Thompson Institute, University of the Sunshine Coast, Birtinya, QLD); Vilas Sawrikar (Brain and Mind Centre, University of Sydney, Sydney, NSW, and University of Edinburgh, Edinburgh, UK); Elizabeth M Scott (Brain and Mind Centre, University of Sydney, Sydney, NSW, and University of Notre Dame Australia, Sydney, NSW); and Jan Scott (Brain and Mind Centre, University of Sydney, Sydney, NSW, and Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK).

Acknowledgements: 

This Supplement was made possible through a one-off grant from the Young and Well Cooperative Research Centre (2014–2016). The research described in the Supplement was supported by a number of funding sources including an Australian Fellowship (464914), a Senior Principal Research Fellowship (1046899), two Centres for Research Excellence grants for optimising treatments for young people with emerging mood disorders as well as suicide prevention (1042580 and 1061043), an investigator grant from Servier Laboratories Australia for circadian research, and the Australian Department of Health for Project Synergy which includes development of the InnoWell Platform. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests:

Project Synergy (2014–2016) was commissioned by the Department of Health and conducted by the Young and Well Cooperative Research Centre in partnership with the University of Sydney’s Brain and Mind Centre. The Department of Health (Australian Government) has further supported Project Synergy through a significant investment over 3 years (2017–2020) which led to the development of InnoWell Pty Ltd, a joint venture between the University of Sydney and PricewaterhouseCoopers (PwC) Australia. The InnoWell Platform is referred to in the Supplement as one example of a technology-enabled solution to reform mental health care services. The University of Sydney and PwC Australia each have a 45% shareholding in InnoWell. The remaining 10% shareholding is evenly shared between Professor Jane Burns and Professor Ian Hickie.

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