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The warning bell has been sounded on the state of primary care and its ability to adequately treat and triage youth mental health conditions.
Former Australian of the Year and prominent psychiatrist Professor Patrick McGorry has called for a reimagining of health care to address the “rising tide” of mental ill health in young Australians.
In a perspective published in The Medical Journal of Australia, Professor 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 youth mental health system involves much more than entry level 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 middle’.”
In an interview with InSight+, Professor McGorry called for urgent reforms to both primary and secondary community health care.
“We need a dramatic increase in upstream investments in primary and secondary community health care and this would take the pressure off emergency departments and crisis lines,” Professor McGorry told InSight+.
Professor McGorry argues 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 over universal health care
He also sounded the alarm on the state of universal health care in Australia.
“Primary care in Australia and in many other countries is in trouble,” Professor McGorry said.
“The financial model has eroded, exposing what has become the mirage of universal health care. Inequity is getting steadily worse.
“There is an overdue need for redesign of the health system and a rethink and revalidation of the role of both GPs and psychiatrists. As with any reform, co-design with those affected, both doctors and the wider community, is the pathway to achieve this.
“Integrated multidisciplinary health care with an expansion of salaried medical and other health professionals should be developed, incentivised and strategically deployed.”
Mental health and mental wealth
The recent National Study of Mental Health and Wellbeing revealed that the prevalence of mental disorders in 16–24-year-olds has risen by 50% — from 26% in 2007 to 39% in 2021. The rise in young women is significantly greater than in young men, with rates reaching 48%.
“Apart from 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, notably 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 almost unlimited expenditures on infectious disease and cancer are driven as much by emotional forces as need, but logic should drive much greater investment in mental illness,” he said.
“Choices are being made non-transparently and there is a need for public debate on the best use of finite health care resources.”
Social media another concern
Professor McGorry also expressed his concern about the impact of social media on young people.
“Young people depend more than most age groups on social connection with peers and face the developmental task of creating safe and stable relationships beyond the family,” he 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 off beam, there are genuine risks.
“[American psychologist] Jean Twenge even argues that the ubiquity of the smart phone is the major 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 potent effects.”
Suggested solutions
In the Perspective, the authors argue for four solutions.
The first solution proposed is prevention and an increasing understanding of the trends occurring in global society.
“The answers are likely to involve a blend of socio-economic and generational changes, rising adversity and inequality, and unforeseen consequences of technological advances,” they write.
The second solution proposed is early intervention, involving integrated primary youth mental health care being the focal point.
“Primary care generally needs reimagining and a new financial model. The surge in need, workforce shortages and the collapse of bulk-billing has created a perfect storm both for GPs and headspace centres,” they write.
The third solution states that young people with more severe illnesses need expert, multidisciplinary teams to recover.
“This requires a more specialised tier of care, a back-up system for primary care providers for young people, so far only available in a small number of ‘oasis’ zones,” they write.
The fourth solution involves redesigning how 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)], should be prioritised and no longer excluded,” they said.
Read the Perspective in The Medical Journal of Australia.
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