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Youth mental health: right level of care needed, first time

4 November 2019
Why simply focusing on early access is not enough
Sydney researchers detail a youth mental health model - the result of years of work from the Brain and Mind Centre - based on their findings that the common 'stepped care' approach may be too little, too late.

A model of care emphasising early access to assessment for young people needing mental health care, and the ongoing provision of stage-appropriate and effective, multidisciplinary interventions, has been proposed by a group of researchers from the University of Sydney’s Brain and Mind Centre.

The details were outlined in a supplement published today by the Medical Journal of Australia (MJA), by leading mental experts from the University’s Brain and Mind Centre, including co-director Professor Ian Hickie.

In an accompanying editorial, also published in the MJA, Professor Hickie explains the model was co-designed with young people and their families, incorporating many evidence-based components.

The authors wrote the measurement-based component of the model would be achieved by “linking individual care to the use of more sophisticated real-time health information technologies that can enhance immediate and continuous clinical decision-making”.

Three core concepts

In the “highly personalised and measurement-based care model”, the authors outlined 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 -- differentiating immediate treatments from secondary prevention strategies; and,
  • three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on proposed pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian).

“It argues for the need to move beyond stepped care, where care typically proceeds from less intensive to more intensive, only after failure to respond to the initial offering, to staged care with the aim of delivering the right level of care, the first time,” Professor Hickie wrote.

“This new model emphasises not simply early access to assessment but also rapid and ongoing provision of stage-appropriate and effective, often multidisciplinary team-based, interventions,”  

“It remains to be demonstrated whether, compared with either existing child and adolescent or adult service models, it results in improved clinical and social outcomes,” Professor Hickie wrote.

How to achieve population-level impact

Professor Hickie concluded that in order to achieve the Morrison Government’s agenda of expanding youth services and reducing youth suicide, it required proper resourcing of the Primary Health Networks (PHN).

“If this youth model of care is more effective, the challenge will be to deliver it at sufficient scale to have real population-level impacts in regions where specialist clinics are not available, so that it connects with populations who are at high risk or traditionally under-represented in care,”

“If PHNs were resourced appropriately and able to access relevant modelling capabilities, health information technologies, information and clinical decision-making systems, and link these with genuine partnerships between young people and their families, it would then be possible to respond much more effectively to the agenda outlined by the Morrison Government.”

If you or anyone you know needs support, please call Lifeline on 13 11 14, Beyond Blue on 1300 22 46 36 or headspace on 1800 650 890.

Declaration: 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 three years (2017–2020) which led to the development of InnoWell Pty Ltd, a joint venture between the University of Sydney and PricewaterhouseCoopers (Australia) (PwC).

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 percent shareholding in InnoWell. The remaining 10 percent shareholding is evenly shared between Professor Jane Burns and Professor Ian Hickie.

MJA supplements are peer-reviewed, paid 'stand-alone' style publications subject to a competitive process.

Ivy Shih

Assistant Media and PR Adviser (Health)

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