Australian Youth Get a ‘Soft Entry’ Into Mental Health System

The most critical period for the onset of mental disorders extends from puberty to the mid-20s, yet that is also the most challenging time of life for teens and young adults to access treatment services, said Patrick McGorry, M.D., Ph.D., at APA’s annual meeting in New York in May.

In the developed world, at least, that cohort is probably in the best physical health in human history, but they still face a surge in risk for depression, anxiety, mood disorders, psychosis, and substance use.

However, if those conditions are identified and treated early enough, it is possible to reduce or eliminate years of ensuing morbidity, said McGorry, executive director of Australia’s Orygen Youth Health and a professor of youth mental health at the University of Melbourne.

Physical health needs rise in middle and older age, but onset and prevalence of mental health problems peak much earlier. Yet systems are designed as if mental and physical health care needs peaked at the same times, McGorry noted.

Early intervention might help, but stigma, fear of being labeled, lack of confidence in the value of interventions, and serious underfunding have led to major access problems, inappropriate and delayed treatment, and reduced quality and effectiveness of care, he emphasized.

Concepts that are the norm in general medical care—like preventive care or treatment of transient illness, age-related conditions like asthma, or even pregnancy—are too often resisted when discussing mental health care, he noted.

Early intervention with young people at risk for psychosis, for instance, might have enormous value, he said. One-third of such individuals transition to full psychosis, compared with the 5 percent to 10 percent of people with high blood sugar who become diabetic. Furthermore, most of those who don’t actually become psychotic will likely still need care for mood, anxiety, or substance use disorders during their lifetimes.

There should be no fear of overtreating these patients, he said.

However, engaging these young people requires a “soft entry,” a way of getting into a system of care without the usual steep threshold of the traditional system, he said. In Australia, that has come in the form of Headspace, an enhanced, informal, drop-in setting.

“Headspace is the National Youth Mental Health Foundation,” says the program’s website. “We help young people who are going through a tough time. Headspace can help you with general health; mental health and counselling; education, employment, and other services; and, alcohol and other drug services.”

Those initial services are backed up by specialists to whom young people with serious symptoms can be referred.

Those with subthreshold symptoms are not dismissed, said McGorry, who helped develop the program. “Young people present with less-specific complaints and symptoms, and so we need a sequential approach with clinical staging to treat them appropriately.”

Headspace has been enthusiastically received both by its young clients and by the 70 communities in which it has been embedded, said McGorry. “At first, communities fought against having mental health services, but now they compete to house Headspace centers.”

This broad-based public support has served as a model for expanding Headspace throughout Australia and for bringing similar programs to other countries, he said.

“When the public wants it, the politicians will respond,” he stated. “You have to expect naysayers and respect, but challenge, the incrementalists. However, in the future, early intervention will be a fundamental aspect of mental health care.” ■