Mental health services for young people – the challenge of integrating services

The argument for increased attention to and resourcing of mental health prevention and early intervention strategies for children and young people is overwhelming. In a recent Access Economics report, it is estimated, that 24.3% of all Australians aged between 12 and 25 years of age suffered from a mental disorder in 2009. The financial cost for each affected individual equates to $10 544 (Aus) per annum, with the majority due to lost productivity, because of lower employment, absenteeism and premature death (1). Furthermore, Australian Bureau of Statistics data in 2007 shows that only 25% of young people aged 16–24 years who have a mental illness receive any treatment (and only 15% of males) compared with 35% of the total population with mental illness (2). Opinions differ as to where along the childhood-early adulthood spectrum increased investment will produce the best overall outcomes. However, governments, clinicians and academics all agree increased investment is needed. The more difficult decision for those who are responsible for service delivery, and the subject which has generated most controversy in the literature, is how services to older adolescents and young adults should be organized and delivered. Birleson argues that it makes more sense developmentally, legally and socially to group adolescents with children than to link them with young adults (3). He additionally suggests that the creation of a youth model will create two transition points (child to youth service and youth service to adult service) instead of the traditional one (from child and adolescent services to adult services). This, Birleson states, will further increase difficulties with continuity of care and he argues that what is required is additional support and funding along the whole spectrum (3). McGorry argues for the development of a youth model, which integrates mental health, drug and alcohol and physical care. This model should be youth friendly, incorporate specialist expertise in relation to a working with young people and their individual culture and give the young person more choice about their care including involvement of family (4). Currently youth mental health services are being established, or being considered, in many countries including Britain, Ireland, Canada and Australia. In Australia, the Federal Government supported the establishment of headspace, the National Youth Mental Health Foundation launched in 2006, and funded the establishment of 30 Communities of Youth Services across the country (5). A recent review of headspace concluded that while there are some ongoing challenges, the headspace initiative has promoted and facilitated improvements in young people’s mental health, social well-being and participation in education, training and employment (6). If the establishment of youth mental health services is to address the many criticisms of them, they must be designed so as to achieve certain outcomes (3,4). Firstly, they must be accessible and acceptable. It is believed that stigma associated with mental illness is even greater for young people than for the adult population (7). Services must be youth friendly, respectful and flexible given that many young people do not fit neatly into the more traditional office-based practice system often associated with traditional child and adolescent services. Sometimes the young person will only be agreeable to speak with a clinician on the first assessment for a few minutes. A rigid assessment process which demands full assessment is unrealistic and risks alienating many young people. Services must, in addition, have the capacity to engage with and support the young person’s family or carer, if that is his or her wish, or to see the young person on their own. The service should not rely on the young person’s family or carer to keep them engaged with the service, as is the case with many existing child and adolescent services. A capacity for outreach is essential in order to engage some clients – something that many child and adolescent services are unable to provide. The inclusion of young people and families in the design and ongoing operation of these services will also support making them accessible and acceptable. Secondly youth mental health services must be integrated with other health services for young people. This is essential for numerable reasons and, in our experience, presents the biggest challenge to their establishment. These services must include primary care services including General Practitioners (GPs) who can provide general health and sexual health services, alcohol and other drug services, rehabilitation services including vocational and educational support, psychological services, occupational and social worker services as well as specialist mental health services. By their very nature young people require a ‘one-stop shop’ for their health needs. Many of the difficulties in relation to access, flexibility and acceptance concerns which we have about young people accessing mental health services also apply to drug and alcohol services and general practice. From the young person’s