1. Evaluating Youth Mental Health
Service Models from around the
Globe
Dr Rick Fraser Consultant Psychiatrist and
Clinical Lead Sussex Early Intervention in
Psychosis Service
SHA Youth Event, Gatwick 17/04/12

2. Youth Mental Health Services Model
Background
• 1 in 4 young people b/w 15-24 will experience a mental
disorder in any 12 month period (Sawyer, 2000)
• 15 - 24 years old is the peak period for the onset of mental
disorders (McGorry 2004)
• Mental health issues are responsible for 65 - 70% of Burden
of Disease for young people aged 15-24 (AIHW 2007)
• Mental and substance use disorders frequently coexist
(70% of help seeking cohorts) ( NSW Health 2007)
• Most young people experience recovery from symptoms of
mental disorders, however there is a significant negative
impact on longer term vocational pathways and economic
participation (Zubrick, 2000)

5. ‘The system is weakest where it needs to
be strongest’ (McGorry, 2010)

6. Transitions
• Education compulsory to 16
• Youth justice system works with children and
young people aged between 10 and 17
• CAMHS up to 18
• Children’s services are generally provided up
to the age of 19
• Children in care can continue to receive
services until the age of 21, or 25 if they are in
education

8. Transitions
• TRACK study (Singh et al, 2009).
– 4 out 90 made ‘optimal’ transition from CAMHS to
AMHS
• Confusing system
• Different eligibility criteria
• Different language
• Varying involvement of family

9. What does research tell us?
• Community-based resources which are friendly,
informal, flexible, accessible and non-stigmatising
• Flexibility in venues and meeting times (including out
of hours, and drop-ins without appointments), plus
telephone support
• Flexibility and perseverance if appointments are
missed
• Services that respond to unexpected changes in the
young person’s mental health and other aspects of
their lives
(Mental health service transitions for young people. Brodie et al, 2011)

10. Options

11. Stay as we are
• Cheaper?
• System works well enough…
• No need to create more interfaces!
• BUT – not meeting the needs of young people
• Likely to be increasing demands with greater
youth unemployment, higher costs of living
fewer opportunities

12. Other models

13. Stand alone
• Health led?
• Specialist
• Makes less use of collaborations/partnerships
• More stigmatising?

14. Integrated
• Partnerships
• Co-located
• Less stigmatising
• Skill-mix and upskilling
• Multiple funding streams potentially more
difficult but may be more sustainable

15. Virtual
• Cheaper
• Acknowledges need for youth services
• Could be built on as funding becomes available
• BUT – not based on meeting needs of young
people
• Unstable and easily dismantled
• Governance/risk issues
• ‘Tick box’

16. Modular
• Access
• Acute
• Community
• Specialist clinics eg EIP, mood disorders, eating
disorders
• A place to begin and grow?

17. Where to start?
• Build on existing services eg EIP, CAMHS, 3rd
sector, Primary Care?
• Collaboration critical in current economic
climate
• Research and evaluate
• Build networks eg YMH Network

18. Current Health Service System for Young People
Primary Secondary Tertiary

19. LOCAL COMMUNITY
Awareness Campaigns, eHealth, & Mental Health First Aid
Broad Youth Mental & Substance Use Disorder Focus
PRIMARY CARE(GPs, School counsellors, CHCs etc)
Specific education for proactive case-finding and non-complex treatment
“headspace”
Youth Services Platform Training and
Supervision
Networks
Specialist Mental Health &
SUD services: ideally
blended and youth-
SPECIFIC DISORDER FOCI
focused

21. Youth portal
Referral from any Signpost out
source Initial generic
assessment
Young Persons Service
Clinical assessment & allocation of PA
Refer out eg GP, 3rd
+/- Brief Intervention sector, SMS etc
Youth Access and
AMHS CAMHS
Transition model
(16-25 year olds in
Crawley)

22. Evaluation
• Evaluation of transitions difficult & complex (Haber
et al, 2008)
• Outcomes
– Employment
– Education
– Criminal justice involvement
– Mental health
– Substance use
• Older individuals did better
• Females did better than males

23. Evaluation – age ranges
• Headspace (Australia) 12-25
• Orygen (Australia) 15-25
• Youthspace (Birmingham) 14-25
• Headstrong (Ireland) 12-25

24. Motivation to change
• Survey of all PCTs (Pugh, 2005)
• 40% CAMHS commissioners and 26% of AMHS
commissioners wanted to develop youth
mental health services
• 15% provided age-specific services
• Increasing interest more recently

25. Future
• Youth health firmly on agenda
• Building locally
• No ‘one size fits all’
• Involve young people, carers/families, local
organisations
• Start small and grow
• Network – build links
• Explore collaborations and funding streams

26. Thank You