Exercise as a novel treatment to improve engagement with mental health services in youth with clinical mental illness: Review and recommendations

The declining mental health of youth in late adolescence and early adulthood represents a serious public health concern, resulting in substantial symptom burden, mortality, and societal cost. Despite this, youth with clinical mental illnesses show poor engagement with mental health services. Two drivers of poor youth engagement in mental health services are ineffective transitions between child / adolescent and adult mental health services, and a loss of youth-specific, needs-appropriate support within the adult mental health services after “ageing out” of child and adolescent services. Such disengagement has serious developmental and functional implications, and is linked to higher hospitalisation and mortality, underscoring the need for improved models of care. Youth often prefer services that help them manage their symptoms, improve their overall wellbeing, support them to participate within their community. In line with this, youth often express preference for, and show higher levels of engagement with recovery-oriented services. Exercise aligns with many tenets of recovery-oriented care by fostering engagement, social connectedness, self-efficacy, behavioural activation, and equipping youth with strategies to improve their wellbeing, manage stress and mental illness symptoms. As such, it represents a practical, accessible, and feasible strategy for engaging youth with clinical mental illness that could be deployed within or alongside existing mental health services. However, it remains underexplored as a vehicle for supporting youth to transition to and engage with adult mental health services. We review the literature in this field and offer suggestions for future research and clinical efforts that integrate exercise into transitional care pathways.