Youth mental health

Youth mental health: A rising public health challenge

From birth to young adulthood, society places a premium on nurturing development to promote health, wellbeing and productivity. While this has produced gains in terms of physical health outcomes (e.g. lower child mortality rates), the mental health and wellbeing of young people, now the number 1 health threat to their lives and futures, has been largely neglected.
A growing wave of evidence has emerged that reveals the extent of this neglect in youth mental health. In Australia, the recent National Study of Mental Health and Wellbeing found that the prevalence of 12-month mental disorder among 16–24 year olds was 39.6% in 2020–21, representing a 50% increase since the 2007 survey.1 Similarly, results from the HILDA survey revealed a substantial decline in the self-reported mental health of young Australians aged 15–24 years between 2011 and 2020, with a sharp decline from 2019.2 These findings have been echoed in other parts of the globe.3,4 The US Surgeon General recently called for immediate systemic change to address the youth mental health crisis, citing a 40% increase in persistent feelings of sadness or hopelessness in high school students from 2009 to 2019.5 The reach of this crisis was evident in the most recent Mental State of the World report.6 In a survey spanning 64 countries, results showed a decline in mental wellbeing with each successively younger generation that was apparent in every country measured.6 A common finding across surveys is a further sharp deterioration in mental health following the onset of the COVID-19 pandemic, especially among young people.2,6
These rising rates of mental ill-health foreshadow potentially devastating consequences on human potential7 and a weakening of young people’s contribution to society that is typically expected once they complete education and training. In 2011, the World Economic Forum estimated that the global cost of mental illness will reach US$16 trillion by 2030,8 which largely reflects the peak onset of mental illness during adolescence and young adulthood and the subsequent loss of productivity. Society as a whole cannot afford continuing inaction on youth mental health.

Key priorities for action

The challenge that currently faces governments, policymakers and society is how to protect and optimise the mental health of young people. This means immediate responses to provide safe, evidence-based mental health care at scale and with quality, and measures to turn off the tap of new cases by tackling known risk factors and harmful megatrends.
First, the latter goal means that prevention, particularly during childhood and adolescence, must be a top priority. We need to better understand why young people across the globe are facing a mental health crisis. While evidence to date strongly suggests that rising rates of illness are explained by socioeconomic, technological, educational and familial factors,9 high-quality evidence is crucially needed to both understand mechanisms and inform preventive strategies. Government policies that directly target social determinants of mental ill-health, particularly socioeconomic inequality and adversity, given the current economic landscape and rising cost of living, are critical. The pandemic has illustrated how swiftly governments can enact public health policies if there is sufficient political will and community support.
Second, the scale and complexity of need among young people can only be addressed and contained by a system which places early intervention as its heart. The optimal approach is to ensure that young people have easy access to a range of options that is both proportional and proactively responsive to their needs (e.g., integrated primary youth mental health care that is backed up by specialist services; school-based services; digital platforms).10 Workforce capacity and quality must be enhanced to ensure that young people have timely access to holistic evidence-based treatments offered with respect and kindness. Ultimately, in every community there should be an integrated youth mental health service offering expert multidisciplinary, health and social care that a young person can access with no or minimal barriers. Headspace in Australia and similar international models have shown that barriers to care can be reduced and access to professional mental health care can be enhanced by establishing youth-friendly primary care-based mental health services that are stigma-free, co-designed and offer a soft entry to care.10 However, an integrated primary care youth service is only one piece of a fully-fledged mental health system for young people. The missing piece is secondary care which can effectively treat more persistent and complex conditions. Entry-level primary care-based models must be seamlessly integrated with a specialised tier of care for young people who need this level or stage of care to recover.
While progress has been achieved in initiating reform in youth mental health care over the last two decades,10 the public and the mental health sector must mobilise and insist that governments and policymakers take further urgent action to reverse the alarming recent trends and protect the mental health, wellbeing and productivity of future generations. This has to be a core pillar of any ‘wellbeing budget’ which goes beyond GDP alone, though GDP will benefit directly and indirectly. Solutions are available both to reduce population risk and also reduce the scale of unmet need. This means public health approaches that target the malleable social and economic determinants of mental disorders and the reinvention of headspace backed by the assembly and scaling up of specialist 12–25 youth mental health services. However, without public demand, political will and adequate investment in prevention, early intervention and a specialised workforce to launch and power these solutions, generations of young people will be at the mercy of demoralising and disabling mental illnesses which will come at a cost to the cohesion and prosperity of our society.

Cover Art

The cover art is entitled Green Man was painted by Brisbane psychiatrist Dr Kieran Forster. Dr Forster describes his artwork as follows: “Here’s the green man. The colour of his countenance refers to both mythic ideas of fertility / youth / creativity / fecundity in early Anglo-Saxon iconography, even earlier Druid prehistory. It also plays on the way colour has very different associations culturally, even now. As my wife pointed out, being Chinese Malaysian Australian, in Chinese culture one might want to avoid the Red Eye or envy / jealousy which is anti-generativity because it means business will be bad or socially you might be so envied, you’re disliked. In Anglicised modern culture, green is both symbolic of nature as well as associated with jealousy. We might have “green eye” for someone, but the Chinese would have “red eye”. In summary, the social and cultural aspect of the human mind is full of contradictions and confusions. This green man is more indicative of a peaceful healing presence, which is how a modern western young person might see him. Just an insight into the colour associations and their cultural complexity behind this otherwise strange painting.”

Declaration of conflicting interests

PM is a founding director of headspace and executive director of Orygen, Australia’s National Centre of Excellence in Youth Mental Health. Orygen is the lead agency for five headspace centres across northwest Melbourne.

 


Reference: Sage Journals

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