Funding review needed to fight youth mental health issues – InSight+

Alarm bells have been sounded about the state of primary care and its ability to adequately treat and assess the mental health conditions of young people.

Former Australian of the Year and leading psychiatrist Professor Patrick McGorry has called for an overhaul of healthcare to address the rising tide of mental health problems in young Australians.

From a perspective published in THE Medical Journal of AustraliaProfessor McGorry, Professor David Coghill and Professor Michael Berk argue that the mental health of many young Australians is rapidly declining (here and here) and that young people with more complex conditions need access to intensive secondary care.

A comprehensive mental health system for young people involves much more than basic primary care, they write.

Young people with more severe, complex or persistent conditions need more expert, sustained and intensive care. Yet this next level of secondary care is largely absent, resulting in a large cohort of young people described as the missing means.

In an interview with Insight+Professor McGorry has called for urgent reforms to primary and secondary community health care.

We need a dramatic increase in upstream investment in primary and secondary community health care and this would ease the pressure from emergency departments and crisis lines, said Professor McGorry Insight+.

Professor McGorry argues that a second tier of care would allow primary care to effectively focus on patients with mild to moderate mental health needs and strengthen engagement outcomes.

Concerns about universal health care

He also sounded the alarm about the state of universal healthcare in Australia.

Primary care in Australia and many other countries is struggling, said Professor McGorry.

The financial model has eroded, exposing what has become the lure of universal health care. Inequality is getting steadily worse.

There is a lagging need to redesign the health care system and to rethink and revalidate the role of both general practitioners and psychiatrists. As with any reform, co-design with stakeholders, both clinicians and the wider community, is the path to achieving this.

Multidisciplinary health care integrated with an expansion of salaried physicians and other health professionals should be developed, incentivized and strategically employed.

Mental health and mental wealth

The recent National Study of Mental Health and Wellbeing revealed that the prevalence of mental disorders in 1,624 year-olds increased by 50% from 26% in 2007 to 39% in 2021. The increase in young women is significantly greater than in young men, with rates reaching 48%.

In addition to the human consequences of premature death and suffering, there is a growing and enormous loss of human potential, social cohesion and mental wealth. [due to mental health conditions]he said.

The authors write that early intervention for potentially disabling illnesses safeguards mental wealth, particularly with psychosis (here).

Health and social care systems remain asymmetrically focused on physical illness and disability, Professor McGorry said in his interview.

It can be argued that the nearly unlimited spending on infectious disease and cancer is driven as much by emotional forces as by need, but logic should drive much greater investment in mental illness, he said.

Choices are made in a non-transparent way and there is a need for a public debate on the best use of limited health resources.

Social media is another concern

Professor McGorry also expressed his concern about the impact of social media on young people.

Young people are more dependent than most age groups on social connection with peers and face the evolutionary task of creating secure and stable relationships beyond the family, she said.

Social media can play a positive role here, but it can also reinforce isolation and expose young people to harm. If the balance is out of range, there are real risks.

[American psychologist] Jean Twenge even argues that the ubiquity of the smartphone is the main driver of the global youth mental health crisis. While there is some evidence for this, in my view other megatrends, mainly socio-economic, are exerting even more powerful effects.

Suggested solutions

In the Perspective, the authors argue for four solutions.

The first solution proposed is prevention and a greater understanding of the trends taking place in global society.

The answers are likely to involve a mixture of socio-economic and generational changes, growing adversity and inequality, and unforeseen consequences of technological advances, they write.

The second proposed solution is early intervention, the focal point of which is integrated primary care for young people’s mental health.

Primary care generally needs an overhaul and a new financial model. The surge in need, workforce shortages, and plummeting wholesale billing created a perfect storm for both primary care physicians and headspace centers, they write.

The third solution states that young people with more serious illnesses need expert and multidisciplinary teams to recover.

This requires a more specialized level of care, a support system for youth primary care providers, hitherto only available in a limited number of oasis areas, they write.

The fourth solution involves redesigning the way funding is distributed through the National Disability Insurance Scheme.

Young people in the early stages of potentially disabling mental illnesses, including treatable neurodevelopmental disorders such as [attention deficit/hyperactivity disorder (ADHD)]it should be prioritized and no longer ruled out, they said.

Read the perspective in The Medical Journal of Australia.

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