Abstract

Mental and substance use disorders are among the leading health and social issues facing society, and now represent the greatest threat from non-communicable diseases (NCD) to prosperity, predicted by the World Economic Forum to reduce global GDP by over $16 trillion by 2030. This is not only due to their prevalence but critically to their timing in the life cycle. They are by far the key health issue for young people in the teenage years and early twenties, and if they persist, they constrain, distress and disable for decades. Epidemiological data indicate that 75% of people suffering from an adult-type psychiatric disorder have an age of onset by 24 years of age. Young people on the threshold of the peak productive years of life have the greatest capacity to benefit from stepwise evidence-based treatments and better health care delivery.  Furthermore, the critical developmental needs of adolescents and emerging adults are poorly met by existing conceptual and service models. The paediatric-adult structure of general health care, adopted with little reflection by psychiatry, turns out to be a poor fit for mental health care.  Youth culture demands that young people are offered a different style and content of service provision in order to engage with and benefit from interventions. In Australia a new system of enhanced primary care, headspace, has been developed for 12 – 25 year olds. This is now operating in 100 communities in Australia.  Access has been greatly improved especially for some traditionally hard to engage subgroups. Outcomes include reduced distress, better functional outcomes and reduced self harm. Similar programs are in place in Ireland, France, Israel, the UK and Denmark and are under development in Canada and the Netherlands. The need for international structural reform and an innovative research agenda represents one of our greatest opportunities and challenges in the field of psychiatry and a huge opportunity for child and adolescent psychiatry which may be able to “come out of its shell” and form the vanguard of mental health reform.

View Patrick McGorry's original ESCAP 2017 slide presentation (pdf, 96 pages).
Read the Patrick McGorry interview.