We have a solution to lift the heavy burden of mental ill-health from young Australians

The mental health of young people has been steadily declining around the world over the past 15 to 20 years. This public health threat finally prompted the US Surgeon General Dr Vivek Murthy to issue a statement late last year on what he acknowledged as the “youth mental health crisis”.

“Every child’s path to adulthood—reaching developmental and emotional milestones, learning healthy social skills, and dealing with problems—is different and difficult. Many face added challenges along the way, often beyond their control. There’s no map, and the road is never straight. But the challenges today’s generation of young people face are unprecedented and uniquely hard to navigate. And the effect these challenges have had on their mental health is devastating.”

A pandemic is a perfect recipe for a crisis in youth mental health.Credit: Rodger Cummins

It prompted President Joe Biden in his State of the Union address this month to announce a national program of investment in youth mental health care.

The pandemic has added further momentum to this public health crisis. All disasters create a surge of mental ill-health and a global pandemic much more so. In May 2020, researchers with the Australian youth mental health organisation Orygen predicted a 32 per cent rise in cases of mental ill-health in young people over the next three to four years. Last November, The Lancet reported that the global increase in anxiety and depression alone had already reached 25 per cent.

However, the burden is not uniform. The Resolve Strategic Survey reported in this masthead showed the pandemic affected the mental health of 82 per cent of Australians aged 16 to 25 compared with 49 per cent of adults over 25. While not all of these young people need professional help, we have witnessed a surge of suicidal behaviour and self-harm in young people which has flooded into emergency departments across the country.

The survey also makes it clear that it was not COVID itself that caused this harm but the restrictions imposed to curb infections. These set up a chain of events that heavily disrupted the scaffolding around young people that was keeping them healthy, namely parental morale, peer networks, educational pathways and a basic sense of security. The report commented that “the medicine was worse than the disease”, at least for young people. Hard data from burden-of-disease estimates confirms this.

The Resolve survey also confirmed young people experienced substantial difficulties in accessing timely mental health care. Waiting lists have expanded, GPs and the youth mental health organisation headspace have no backup system, and the emergency department ends up being the only place to seek help, typically in desperate circumstances.

No one can now deny or minimise the reality of this crisis which has been building for almost two decades. So, what is to be done?

The obvious first step is to understand what is creating it. A familiar response is to invoke the “snowflake” theory and blame young people themselves for their suffering (see the letters pages). They should just be more resilient as in previous times.

A more evidence-based response is likely to be a better guide to prevention. The answers are likely to lie in an analysis of megatrends of recent decades which have affected emerging adults. The candidates include rising socioeconomic inequalities, wealth transfer from young people to older generations, the insecurity of working conditions and career paths, the cost of housing and higher education, climate change and the impact of social media and smartphones.

For this reason, we have established the Orygen Institute, to be launched in May, to harness a broad range of public intellectuals and experts to analyse and synthesise the evidence to guide prevention strategies.

The response to any public health crisis is a mix of prevention and treatment. Prevention will depend on clarity, require a mighty effort and take time. In the meantime, we need to fully commit to responding not only to what we have termed the “shadow pandemic” but to the underlying crisis that preceded it.

There are some positive developments in Australia to build on. First, successive federal governments, including the Morrison government, have built a base camp for access to youth-friendly primary care in the headspace network which will soon reach 164 centres.

In Victoria, the Andrews government, through its royal commission, has decisively aligned the state mental health system with headspace’s 12-25 age-group focus, supported cultural change and substantially boosted funding. These reforms are genuine and have inspired similar reforms in other countries. However, they are merely a base camp on the ascent to a solution.

Headspace is a primary care model unlike the new adult Head to Health centres, also created by the federal government, which are secondary backup systems. A headspace centre receives much more limited funding and is designed to offer only brief episodes of care. This means that up to two-thirds of the young people who, while they benefit from ease of access, fail to recover with primary-level care alone. They need an extra level and duration of care within a multidisciplinary team for their more complex and persistent conditions. We call these young people the “missing middle” and their numbers are substantial. They, too, need a backup system.

Fortunately, we have a solution at hand. A decade ago, a secondary backup system for headspace centres was designed and deployed by the federal government in six regions of Australia as a partial solution to the missing middle. Branded EPYS (Early Psychosis Youth Services) and limited to young people with early psychosis, it has resulted in positive outcomes which rival or exceed those seen anywhere in the world.

This cost-effective model of care is essential for all the conditions that make up the missing middle, notably complex mood disorders, eating disorders and borderline personality. As we have shown in Melbourne, it can be efficiently expanded to cover all these conditions using the same infrastructure.

With the extra surge of the shadow pandemic upon us, every Australian community urgently needs this backup system to deliver expert support to GPs and to headspace centres and early intervention and better outcomes for the young people and families.

As we enter the budget and election period, funding for existing EPYS centres needs to be secured and their diagnostic focus quickly expanded. And over the next four years, we need to see this model established in 24 regions and communities to transform outcomes for young people Australia-wide. This is crucial for the recovery phase of the pandemic and for the future of our society.

Support is available from Beyond Blue on 1300 22 4636, Butterfly Foundation on 1800 334 673 and Lifeline on 13 11 14.

Professor Patrick McGorry is executive director of Orygen, the centre for youth mental health at the University of Melbourne, and a former Australian of the year.

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