Youth mental health: We need teens to help shape support services - Dr Ian Soosay

"Across the globe, in rich and poor countries alike, we are seeing declines in the mental health of young people." Photo / 123RF

THREE KEY FACTS

• The Lancet Psychiatry Commission on Youth Mental Health is a call to action for policymakers, health professionals and society to address the global youth mental health crisis.
• Its purpose is to ensure the design, structure and capacity of youth mental health care is fit for purpose.
• The commission identified that mental illnesses have their peak onset at age 15 years, and early intervention is crucial.

Dr Ian Soosay is a psychiatrist and honorary senior lecturer in the Department of Psychological Medicine at the University of Auckland.

OPINION

“What you do must be so hard” is the common response when I meet someone for the first time and tell them I work in mental health.

“You know, with our terrible youth suicide rate and everything.” I take a deep breath and launch into my well-practised reply on how much I enjoy my work as a psychiatrist, how as a doctor I genuinely love my job, that mental illness is treatable for most people, and that it is extremely satisfying and rewarding to help people get back on track with their lives.

Nevertheless, I am starting to feel a little overwhelmed by the pessimism of the New Zealand public in this area, to the extent I have even started to contemplate lying about my profession to spare myself the awkward conversations.

My robustness as a generally optimistic proponent of mental health took a further hit earlier this month. In my academic role, I have been involved in a wonderful piece of work called the Lancet Psychiatry Commission on Youth Mental Health, an international collaboration to draw together evidence and expert opinions on the challenges and potential solutions.

The prestigious medical journal published our findings and recommendations. It should be essential reading for politicians or policymakers wanting to make a difference to improve the mental health of our young people.

However, a lot of the paper is not good news.

Across the globe, in rich and poor countries alike, we are seeing declines in the mental health of young people.

The paper explores “megatrends” that may be driving this change - from structural societal models, social isolation and economic impacts to changes in developmental stages and through to global challenges like climate change and social media.

We have inadvertently made changes to the way we live that have either impacted on the propensity of young people to develop mental illness, reduced their resilience or both, and we need to urgently do something about it.

I do not think that any of this should be controversial in New Zealand.

We have had a consensus across the political spectrum for many years regarding better youth mental health, from Sir John Key’s Youth Mental Health Project and Dame Jacinda Ardern’s Wellbeing Budget to our current Minister of Mental Health Matt Doocey’s target of allocating 25% of investment to prevention and early intervention.

We also have an energetic and innovative youth mental health sector who have often been world-leading in thinking about how we serve our young people. In the commission discussions, I was struck by how many people told me they had been inspired by New Zealand service innovations, and the paper lists many opportunities for action.

So, what has been stopping us? Why have we not got more traction?

I think there are a few things that we should think about. Firstly, the good old Kiwi number-eight-wire approach does not work when we have to take things to scale.

Minister for Mental Health Matt Doocey.

Many of the elements we need - technology platforms, marketing and branding, workforce training and integration across agencies - are expensive and need to be of a reasonable size to be affordable. These need to be national models, and some of the recent changes to our health system might make this easier.

Secondly, we need to avoid the temptation of pilots and trials to fit into an envelope defined by Treasury in a single budget cycle. A 10-year rollout is probably realistic and would therefore require cross-party commitment.

Thirdly, we should stop pretending investment in youth mental health will come from savings we will get from current expenditure in specialist adult mental health services.

The bulk of the costs in those services are linked to a relatively small group of people who have severe and expensive-to-treat conditions such as schizophrenia. Defunding services to that group will only result in a different mental health crisis in an even more vulnerable population.

Lastly, but most importantly, we need to empower the voices of our young people to shape the sorts of services they want and fund them appropriately.

We are ageing as a society, and most experts believe we will have to spend an increasing proportion of our expenditure on health.

We should be mindful about inter-generational fairness and ensure a proportion of that expenditure goes to youth. Failure to do so will lead to falling wellbeing in our communities and workforce, which will have massive financial and societal impacts for decades to come.

Despite the challenges, I remain optimistic about the future of youth mental health. I might just hold off telling people at social gatherings I am an accountant for a little bit longer.