This is why we need to change our approach to young people's mental health

One of the primary goals of all societies is to ensure that their children have the chance to become healthy adults able to contribute back to their communities. Historically, one of the main obstacles to this has been childhood mortality, with nearly 50% of children dying before five years of age 200 years ago. Over the last 80 years childhood mortality has been cut to less than 4% globally. The current main obstacle preventing young people reaching healthy adulthood is mental health.

Mental illness is one of the biggest issues facing young people. Most mental illness has its onset in adolescence and early adulthood with 75% of mental illness presents by the age of 25 years. This is a time of life full of transitions in their relationships, education, work and housing. The onset of mental illness at this time in life can disrupt or derail development in one or many of these life areas.

One in four people experience mental illness, although recent research suggests that the actual proportion may be double that. As a consequence, not only is there a significant personal cost to the individual with mental illness and their loved ones, but a massive societal and economic cost to the wider community. A report from the World Economic Forum and Harvard found that mental illness contributes the largest share of lost economic global output of any non-communicable disease. The report estimated that by 2030 mental illness would lead to losses to global output equivalent to US$16.1 trillion.

Most mental health systems are structured on child and adult systems, with the cut-off point being 18 years – right in the middle of the typical onset of mental illness. This requires the young person and their family to navigate a new and often quite different system when they are least able due to crisis or distress. Support for young people is at its weakest where it needs to be strongest. Further, there tends to be no input from young people or their families in terms of either policy, service design or service offerings. Finally, existing mental health services tend to be poorly integrated with the wider service system addressing the diverse needs experienced by young people with mental illness, such as the education system, welfare, housing and other supports. This is clearly a situation that needs to change.

An antidote to this picture is Youth Mental Health. Youth Mental Health is a movement of young people, families, researchers, clinicians and others that has grown over the last 25 years. This movement recognises the centrality of the young person in designing and providing a mental health response. Youth Mental Health disrupts a previously binary system and instead empowers young people to own their experiences and take on their role as stakeholders. The “Nothing about us, without us” mantra is a key point of difference embodied by the Youth Mental Health movement.

Ignoring traditional arbitrary age divides, it instead looks to the evidence of onset and provides service to those aged 12-25 with flexibility at both ends of this age spectrum. Youth mental health seeks to provide a response which not only addresses the symptoms that a young person is experiencing, but also the effects that those symptoms are having on their life, be those struggles in education, employment, housing, social relationships or managing physical or sexual health. Traditional mental health systems erect barriers (occasionally literal) to entry, but youth mental health takes a no-wrong-door primary care approach – young people can just walk in and ask for the help that they need. Despite the promise of this approach, it has only been realised in a relatively small number of high-income countries.

In 2019 the Forum partnered with Orygen, a world leading youth mental health medical research centre in Australia, to develop a global framework of youth mental health that could be used to develop youth mental health responses in any resource setting. The project involved consultation with more than 600 young people in over 50 countries across a range of resource settings. Young people told us that stigma and availability of mental health care were major barriers to seeking mental health care. And that even when help was sought there were varying amounts of belief that the help received would be good. By meeting and listening to young people from all country income groups, they told us about three consistent mental health concerns. These included the burden of comparison caused by social media; academic pressure to achieve, and; worry about the impact of climate change on life opportunities. Although consultations were concluded before the current crisis, there is little doubt that the health and economic impact of COVID19 would also be a major cause of distress to the young people of the world.

Through consultation with young people, academic experts, professionals, families, health care and health industry leaders a framework was developed. The framework has 8 core principles:

But key to the implementation of these principles is local interpretation. Local stakeholders need to interpret these principles in their own local context.

Through the project we also witnessed the ways in which young people are standing up and implementing solutions that are improving youth mental health care today and for future young people. And so in addition to the framework an advocacy toolkit was developed – again co-designed with young people – to liberate and focus this energy.

Progress in addressing mental ill health has often been stymied by stigma and prejudice, and while those factors continue to exist, they are being met with a generation of young people who are not shy to talk about their experience of mental health and mental ill health. Increasingly experiences of mental ill health are not met with a cold shoulder, but a shoulder to lean on. The Global Framework for Youth Mental Health which will be officially launched on May 27 is a blueprint for society to join with young people to reduce stigma around mental ill health, to advocate for positive change and to ensure that the next barrier to reaching a successful adulthood is removed.