Introduction by Croakey: Preliminary recommendations from a sector-led consortium exploring Australia’s youth mental health system include calls to strengthen and expand youth mental health organisation headspace, pilot ‘care navigators’ to help young people access and interact with mental health services, and to build a national person-centred data system.
Feedback has been sought on these and other recommendations for refining youth mental healthcare from service providers, and other stakeholders including young people, families and carers. The Models of Care Consortium, led by Orygen and involving other youth mental organisations across Australia, is expected to finalise and deliver its advice to the Department of Health and Aged Care in June.
Below, Dr Sebastian Rosenberg and Professor Ian Hickie, from the Brain and Mind Centre at the University of Sydney, argue for a personalised response to young people’s mental health needs, as well as the integration of “clinical and psychosocial aspects of mental healthcare, responding not only to symptoms, treatment and medication needs, but also to critical contextual factors like housing, education and social support”.
Sebastian Rosenberg and Ian Hickie write:
One of the key challenges facing the incoming Federal Government is surely youth mental health.
Recent data suggests that the prevalence of operationally defined mental disorders in 16 to 24‐year‐olds rose by 50 percent – from 26 percent in 2007 to 39 percent in 2021. In 2023, mental health conditions, substance use disorders and injuries contributed the most health burden for young people aged 15–24.
Keen to organise a response, the Commonwealth Department of Health in late 2024 put out a tender seeking advice about new models of youth mental healthcare.
This tender was won by a consortium, led by Orygen, and involving about 20 different organisations from across Australia, including our own, as well as youth advocacy and consumer groups.
As this group has grappled with the issues at stake, it has conducted nationwide consultations and tried to develop a fairly complete picture of what is already happening.
This isn’t easy.
A bewildering landscape
In the youth mental health space, clearly headspace is a prominent player. In the midst of COVID in 2021, headspace reports supporting more than 100,000 young Australians.
Another big service provider is the Child and Adolescent Mental Health Services (CAMHS) run by each state and territory.
As is often the case in Australia, good, recent data is hard to find. However, in 2018–19, the Australian Institute of Health and Welfare reports that young people aged 12–24 accounted for:
- 28 percent (124,900) of community mental health care service patients
- 22 percent (4,100) of same-day admitted mental health-related separations from public hospitals with specialised psychiatric care and 17 percent (6,800) of those without specialised psychiatric care
- 20 percent (34,200) of overnight admitted mental health-related hospital separations from public hospitals with specialised psychiatric care and 11 percent (10,600) of those without specialised psychiatric care.
In 2022-23, young people accounted for 22 percent of all mental health-related emergency department presentations in public hospitals (65,556 out of 287,419).
The Institute of Family Studies reports that the use of specialist mental health services by young people still represents a small proportion of overall service use (3.3 percent). Mental health problems in young people are mostly dealt with in primary care and the education system.
Young people had most commonly seen a general practitioner for their problems (35 percent) in the past 12 months. About one-fifth had seen a psychologist (24 percent), paediatrician (21 percent) or a counsellor or family therapist (21 percent).
Schools provided services to two-thirds of young people with mental disorders. The most common service was individual counselling (28 percent), which was used most frequently by adolescents.
Health systems also offer sexual health services and drug and alcohol services, both commonly required by young people with co-occurring mental health needs. These were both supposed to be part of the original headspace service model but are now only rarely available.
States and territories also provide a range of youth specific services, dealing with issues like housing, welfare, justice and community services.
Young people may also access mental healthcare through telephone counselling or though the burgeoning range of online mental health services now available not just in Australia, but worldwide.
Into this complex and fragmented environment (or perhaps because of it), the Federal Government has now, in addition to the development of new youth models, also commissioned SANE Australia to develop a new national digital navigation system, to help people, including young people, find the right care sooner.
The Federal Government already funds some enhanced youth mental health services, provided by a combination of state and NGO providers.
The Government has also promised a new national digital early intervention service, to provide free cognitive behavioural therapy (CBT), delivered by skilled and trained professionals, via phone or video. This service would presumably aim to take some of the pressure off the face to face service system provided under Medicare’s Better Access Program.
And of course a critical element of the Federal Government’s mental health reforms thus far has been the establishment of new Medicare Mental Health Clinics (formerly Head to Health).
Diverse models for diverse needs
Young people with mental illness seeking care face a bewildering range of options.
The right care pathway is far from obvious. It is easy for the young person and their families to become frustrated or lost. Technology can assist in the coordination of care and monitoring a person’s progress.
As we look to build new models of youth mental healthcare now, we need to not only acknowledge this complexity, but also respect the diversity of mental health needs experienced by Australia’s young people.
Simplistic divisions into steps like ‘mild’, ‘moderate’ and ‘severe’ fail to grasp this complexity and also diminish the need to think systemically.
Without even considering the very practical constraints imposed by existing workforce limitations, just building more youth-specific beds, or more headspaces is not going to address this complex and diverse picture, and certainly not at the necessary scale.
Australia’s young people need a personalised response to their mental health needs, underpinned by strong coordination, monitoring and measurement. We need to understand if they are getting better or worse.
They need access to both clinical and psychosocial aspects of mental healthcare, responding not only to symptoms, treatment and medication needs, but also to critical contextual factors like housing, education and social support.
As is often the case in Australia, bits of effective models already exist, in some places.
Orygen’s Models of Care Consortium is finalising its advice to government now. Nationwide consultations have taken place and submissions are currently invited from young people and their families.
We need to build on these foundations to develop the range of effective models necessary to better meet the mental health needs of young Australians, investing now to save massive costs later.
About the authors
Dr Sebastian Rosenberg is a Senior Lecturer at the Brain and Mind Centre, University of Sydney
Professor Ian Hickie is the co-director of Health and Policy at the Brain and Mind Centre, which operates early-intervention youth services at Camperdown under contract to Headspace. He has previously led community-based and pharmaceutical industry-supported (Wyeth, Eli Lily, Servier, Pfizer, AstraZeneca, Janssen Cilag) projects focused on the identification and better management of anxiety and depression. He is the Chief Scientific Advisor to, and a 3.2 percent equity shareholder in, InnoWell Pty Ltd, which aims to transform mental health services through the use of innovative technologies.
Related articles published in the past week
- Calling for national leadership to address workforce shortages in community mental health services
- Improving mental healthcare for Aboriginal and Torres Strait Islander people: new research findings
- Five priorities for the Albanese Government to transform Australia’s mental health system
Support services
Lifeline: 13 11 14 or text 0477 13 11 14 for 24/7 crisis support and suicide prevention services
13YARN: 13 92 76
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The Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention (CBPATSISP)
Suicide Call Back Service: 1300 659 467
Kids Helpline: 1800 55 1800
MensLine Australia: 1300 78 99 78
Beyond Blue: 1300 22 4636
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See Croakey’s archive of articles on mental health
