Plea for urgent youth mental health overhaul

A trio of Australia’s leading psychiatrists have launched a scathing review of the nation’s healthcare system amid a ‘rapidly declining’ youth mental health crisis.
 
Headspace founder Professor Patrick McGorry, University of Melbourne Developmental Mental Health Chair Professor David Coghill, and Barwon Health Psychiatry Chair Professor Michael Berk joined forces for an article published earlier this week in the Medical Journal of Australia.
 
They said improved access to early intervention is crucial, as ‘the surge in need, workforce shortages and the collapse of bulk billing has created a perfect storm both for GPs and headspace centres’, but that action is not being taken to match the scale and urgency of the crisis.
 
Dr James Best, Chair of RACGP Specific Interests Child and Young Person’s Health, has backed the report, telling newsGP a different approach is urgently needed.
 
‘The heavy lifting, as is so often the case, is done by GPs and, by default, most youth mental health issues are dealt with still by GPs and will continue to be so,’ he said.
 
‘We are inadequately funded to do this very difficult work. I also think that there needs to be an increased focus on training of GPs in not only mental health, but child mental health as well.’
 
Headspace’s latest National Youth Mental Health Survey found 57% of young people believe their mental health is getting worse, and suicide remains the leading cause of death for Australians aged 15–24.
 
The report said Australia’s fragmented model of care is ‘diffuse, piecemeal, poorly integrated and regulated, typically non‐evidence‐based, confusing to the public, and, ultimately, ineffective’.
 
It also raised significant concerns about the ‘missing middle’, a cohort of young people who are missing out on the expert, sustained, and intensive care they need, and called out the National Disability Insurance Scheme (NDIS), saying it is ‘poorly serving’ those with mental illness.
 
‘Early intervention and recovery, essential principles of youth mental health, are in direct conflict with the current NDIS model, which therefore makes any return on investment impossible,’ they said.
 
The report labels the current scheme as ‘self-defeating’ and in need of significant transformation, and calling for a rethink of the NDIS, and the addition of treatable neurodevelopmental disorders such as attention-deficit hyperactivity disorder (ADHD).
 
Dr Best agrees, saying mental health should be covered by the scheme.  
 
‘These things can be disabling, as in the “D” for NDIS, so why do we allow some conditions and not others?’ he said.
 
‘To see a person, for example with ADHD, or with depression, or anxiety, and not give them the support that would make them retain their mental wealth, that is a waste to society and to the individual.
 
‘We’ve got state versus federal funding systems, we’ve got private versus public – it’s all over the shop.’
 
Looking for solutions, the article said there is an urgent need to investigate the risk factors and megatrends leading to mental health decline.
 
It also says Australia’s divided systems are in need of reform, with the status quo ‘spawning a bewildering array of competing, siloed and often rotating and transient non‐government organisations which deliver “salami slices” of health and social care’.
 
Dr Best said without intervention, the crisis will only worsen.

‘If you allow mental health to deteriorate when it doesn’t necessarily have to, you’re squandering that wealth, and you’re wasting it,’ he said.
 
‘It can be really challenging when you have someone in crisis in this sort of age group and it can be very frustrating that there just aren’t the resources.’
 
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