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Addressing the paradox of the youth mental health crisis through a focus on prevention

Introduction by Croakey: Psychological distress has markedly increased in young people aged 15 to 24 years since 2011, according to the latest annual Household, Income and Labour Dynamics (HILDA) survey.

While psychological distress has increased across all age groups in recent years, the increase has been “most severe” for 15 to 24 year olds, rising from 18.4 percent in 2011 to 42.3 percent in 2021.

Highlighting the importance of addressing the social determinants of health, the survey found a higher likelihood of psychological distress among people who were unemployed, compared with those who were employed.

Similarly, those on lower incomes have a higher likelihood of experiencing psychological distress.

“Income support recipients are significantly more likely than non-recipients to report psychological distress,” the report states.

This is the first year the HILDA survey has collected data during the pandemic, finding that psychological distress is more likely among people residing in Victoria during the 2021 COVID-19 lockdown than among people who did not live in Victoria during that period. No association was found between psychological distress and the NSW/ACT lockdown in 2021.

Below, Dr Sebastian Rosenberg, Associate Professor Jo-An Occhipinti, Dr Adam Skinner and Professor Ian Hickie from the Mental Wealth Initiative – Brain and Mind Centre, University of Sydney highlight new research that may “reshape mental health policies and interventions”.


Sebastian Rosenberg, Jo-An Occhipinti, Adam Skinner and Ian Hickie write:

Noting the paradox of greater investment in youth mental health services occurring at a time of declining mental health outcomes, new research suggests that greater success could be achieved through a multifaceted mental health promotion and prevention program.

Australia has recognised the merit of investment in the mental health and wellbeing of its youth. With 75 percent of all mental illness emerging before the age of 25, myriad programs including headspace have emerged over recent years.

Despite this, there is evidence indicating that the mental health of young people has significantly declined over the past decade. Recent data from the HILDA survey also indicate younger Australians are experiencing higher psychological distress and more loneliness compared to older age groups.

Adolescence and early adulthood are pivotal periods for establishing social, cultural, emotional, and educational resources. The onset of mental health problems during this stage of life is a predictor of adverse longer-term socioeconomic and health outcomes, including failure to complete schooling, unemployment, low income, welfare dependency and poor physical health.

If we can prevent or respond better to the onset of mental illness among Australia’s young people, there would be enormous benefits both to the individuals and their families, as well as the whole community. Therefore, preventing the onset of mental illness during adolescence and early adulthood is important both for individuals and the societies of which they are a part.

Preventive interventions

Preventive interventions for improving mental health can be divided into three types:

  1. universal interventions, which are delivered to a general target population – for example, mental health awareness programs for school students
  2. selective interventions, which target healthy individuals exposed to one or more risk factors that increase their chance of developing a mental disorder – for example, preventive psychological interventions for children of parents with depression
  3. indicated interventions, which aim to prevent young people with mild early symptoms of mental disorder from progressing to full-threshold disorders, typically through the provision of psychological or social interventions.

Universal preventive interventions are generally assumed to be more effective than targeted interventions in reducing the occurrence of mental illness at a population level.

However, our recent research – published in Scientific Reports Journal last year – challenges the simplicity of this assumption and offers insights that can reshape mental health policies and interventions.

Understanding the research

Our research focuses on the population-level effectiveness of the three approaches – universal, selective, and indicated – to preventing mental disorders in adolescents and young adults.

We used a dynamic model that considers the onset of mild symptoms and progression to more severe diseases. This modelling brings together a variety of evidence, such as research, expert knowledge, practice experience and data, to capture the complexity of a problem.

The model is then used as a ‘what-if tool’ – to simulate various policy scenarios to see which is likely to have the most effect. Getting this right takes time but it offers promise in being able to better use diverse evidence sources to support decision making for complex problems, and provides a platform for consensus building and strengthening relationships between policy makers, stakeholders, and researchers.

Our study reveals two key findings.

Firstly, indicated preventive interventions targeting individuals with milder symptoms can be more effective in reducing mental distress prevalence than universal interventions.

This finding challenges the conventional belief that a ‘high risk’ prevention strategy is generally less effective than a whole-population strategy.

Secondly, the modelling clearly shows that universal interventions have greater potential for preventing mental disorders than selective interventions, which is consistent with the widely accepted view.

Real world implications

While universal interventions have substantial potential, indicated interventions, specifically targeting those with milder symptoms, can yield greater population-level impacts (from currently available interventions).

These findings suggest that increasing investment in interventions aimed at promoting early engagement with mental health services and enhancing treatment for young people – for example, the use of health information technologies to deliver highly personalised care – is likely to be crucial if we are to adequately address the currently limited effectiveness of mental disorder prevention programs worldwide.

A major challenge, currently being considered by Minister Butler’s Mental Health Reform Advisory Committee, lies in scaling up service capacity in mental health to achieve the ambition of providing enhanced treatment for those experiencing milder symptoms.

There has been substantial growth in services in Australia since the early 2000s, marked by reforms such as the Better Outcomes in Mental Health Care and the Better Access Program (resulting in a 125 percent overall increase in the provision of services in the subsequent 10 years), as well as the establishment of over 150 headspace service centres since 2006.

However, there are obvious questions regarding the sustainability of this historic rate of growth.

There is a range of real-world constraints to expanding mental health services capacity in Australia and elsewhere. Issues include workforce shortages, an aging workforce, staff turnover, quality and training concerns, and challenges in attraction and recruitment.

Additionally, in the pandemic erea, burnout among mental health professionals and increasing part-time only practice are significant and ongoing problems.

Structural reform needed

Serious structural reforms are needed to improve the availability, timeliness, and effectiveness of care including addressing the structural, systemic, organisational, and individual factors that affect the growth, retention and resilience of the mental health workforce, and technology-enabled improvements in mental health system coordination and performance.

Constraints on continued growth of clinical services, together with stunted investment in psychosocial alternatives, increase the argument in favour of the promotion of universal primary prevention.

Our modelling study also suggests that universal strategies that are effective at an individual level, such as tackling economic risk factors, have the potential to deliver substantive reductions in the prevalence of mental health problems.

Governments can enhance social and economic inclusion for young people by implementing policies that reduce financial stress and support affordable housing, accessible education, and quality employment opportunities, thereby contributing to improved mental health and overall wellbeing.

This research challenges the traditional, unhelpful split between high-risk and whole-population prevention strategies, indicating instead a more tailored and nuanced approach.

Promotion and prevention remains a peripheral element of total mental health spending in Australia, probably around only 10 percent.

Based on our research, rather than just continue to support and expand existing youth mental health services in Australia, governments should consider funding instead a multifaceted prevention program, combining universal and indicated interventions, as the most effective way to really help young people reduce their distress and better manage their mental health.

Dr Sebastian Rosenberg is a Senior Lecturer at the Brain and Mind Centre, University of Sydney and also Associate Professor, Health Research Institute, University of Canberra. Associate Professor Jo-An Occhipinti is the Co-Director of the Mental Wealth Initiative at the Brain and Mind Centre. Dr Adam Skinner is a Senior Research Fellow on the Mental Wealth Initiative. Professor Ian Hickie is the Co-Director, Health and Policy at the Brain and Mind Centre, University of Sydney.

Note from Croakey

On related matters, researchers from the United Kingdom, United States and Canada have developed a road map for addressing the social determinants of mental health – such as poverty, loneliness and discrimination. It includes a recommendation that social justice be central to all public mental health interventions. Read more in the latest ICYMI column.

Crisis supports

13YARN is a crisis support line for Aboriginal and Torres Strait Islander people. Available 24/7. No shame, no judgement, safe place to yarn.
Phone 13 92 76

Kids Helpline provides free, private and confidential 24/7 phone and online counselling service for young people between the ages of 5 and 25.
Phone: 1800 551 800

Lifeline provides free suicide and mental health crisis support for all Australians.
Phone: 13 11 14

Beyond Blue provides free telephone and online counselling services 24/7 for everyone in Australia.
Phone: 1300 224 636

1800 RESPECT provides confidential sexual assault and family and domestic violence counselling via phone and webchat. Available 24 hours a day, seven days a week.
Phone: 1800 737 732


See Croakey’s archive of articles on mental health