Spotlight on youth mental health

In Sydney late last year, paediatricians, psychologists and psychiatrists gathered to discuss the continuities and discontinuities of youth mental health. The forum, a first of its kind, provided an invaluable opportunity to hear the latest research on this important field of study. Its interactive nature enabled participants to give their opinion on topics as diverse as the biological underpinning of mental illness, pathways to offending, genetic links and strategies to improve youth mental health services.

The inaugural forum, ‘Continuities and Discontinuities of Youth Mental Health’, attracted a range of participants, including paediatricians, psychologists, psychiatrists and others involved or interested in child and adolescent mental health. The forum was held in Sydney on the 9^th and 10^th of November, and provided a rare opportunity to hear the latest research and debate current issues in the field of youth mental health.

The Chairperson, Professor Philip Hazel, outlined the aim of the forum, which was to emphasise the need for continuity of care from childhood to adulthood. In particular, to define transitional needs and develop treatment plans that account for patterns and stages of development. Professor Hazel stressed that most adult mental illnesses have their roots in adolescence, and sometimes even childhood. By improving the continuity of care between these stages of life, the burden of mental illness could be significantly reduced.

Dr Daniel Hermans from the Brain Dynamics Centre at Westmead Hospital in NSW presented evidence for a biological basis of mental illness. He focused on the three most widely studied conditions of childhood – attention deficit/hyperactivity disorder (ADHD), conduct disorder (CD) and oppositional defiant disorder (ODD). The presentation highlighted the complex interactions and mechanisms of transition between the three disorders. Dr Herman hopes that, "A focus on different sub groups will help disentangle neurobiological continuities and discontinuities which are particularly relevant given the range of potential outcomes in adulthood."

Given the high rates of mental illness in the young offending population, it was important to address the possible determinants. Dr Claire Gaskin, a Consultant Forensic Adolescent Psychiatrist, explained that youth are more likely to offend if they have been victimised or traumatised in the past, have a learning disability or abuse substances. These adolescents are at an increased risk of lifelong physical and psychiatric disorder, unemployment, schizophrenia, death, suicide and serious accidents. When asked if targeted intervention in childhood and adolescence could delay the onset of mental illness in adulthood, almost two thirds of the audience said they strongly agreed.

The genetic basis of mental illness was a highlight of the forum and was explained by Professor David Hay from the School of Psychology at Curtin University. Professor Hay said that although there is no single gene for mental illness, there is strong evidence for a genetic component which influences the progression of the illness. He did, however, approach the research with caution by using an example, "Are the relationships between anxiety, depression and ADHD genetic, or are anxiety and depression a consequence of the way ADHD impacts the child?" he questioned.

The topic of bipolar disorder was addressed by Professor Gib Mahli from the Department of Psychology at the University of Sydney. Professor Mahli made the point that almost all children and adolescents who have a bipolar episode will experience a recurrence in adulthood. This provides a strong argument for ensuring the continuity of care. The results of brain imaging studies were presented to show that bipolar disorder is the result of emotional deregulation and underdevelopment of the frontal cortex.

The forum ended with the practical implications of the research. Professors Patrick McGorry and Ian Hickie from the National Youth Mental Health Foundation (‘Headspace’) spoke of ways to improve the provision of mental health services for young people. They identified primary care as they key area for improvement. Professor Hickie stressed that, "We need systems in which specialists are actively engaged with GPs…at the moment it’s a highly disconnected system." This thinking was clearly supported by the audience, with the majority stating that the coordination and provision of ongoing multidisciplinary care was the most important aspect of collaborative care models for the treatment of anxiety and depression.

The forum was well received by all participants and the presentations were both engaging and of high quality. It gave those involved in the field of youth mental health an opportunity to reflect on the continuity of care from childhood through to adolescence, and then into adulthood. It is hoped that knowledge gained from the forum will translate into improved treatment and better patient outcomes. This will require a collaborative and multidisciplinary approach, but the long term benefits to young patients will be invaluable.

Click here to view the highlights of the inaugural forum.

Reference:

Continuities and Discontinuities of Youth Mental Health. Inaugural Forum. Sydney. 9^th – 10^th November 2007.