Journey for young minds has many bumps in the road

Youth mental health is such a “buzz” phrase these days that it is hard to believe it was hardly discussed in Ireland just a decade ago.

The emergence of this distinct health concern is linked to growing evidence of high rates of mental health problems among young people during their adolescent and early adult years. Some 75 per cent of adults with a mental disorder will have first experienced it before the age of 18, according to research in New Zealand.

However, as the Irish-born Australian psychiatrist and reformer Prof Patrick McGorry has pointed out, despite the evidence that the onset of mental ill-health peaks in youth, it is during this crucial developmental period that mental health services are weakest.

"This has resulted in significant numbers of young people being excluded from or unable to access mental health services at the very time that they need them most," writes Helen Coughlan in the latest edition of the College of Psychiatry of Ireland's scientific journal Irish Journal of Psychological Medicine, which is devoted to the topic of youth mental health.

Just how treacherous the journey through adolescence can be for a young person’s mental health is starkly illustrated by a landmark, two-stage Irish study of the incidence of psychiatric disorders. An analysis of the results of the second phase is included in the journal.

Conducted among young people in north Dublin, the first stage of the Challenging Times study found 15.6 per cent of the children aged 12-15 interviewed met the criteria for a psychiatric disorder.

Seven to eight years later, a follow-up of this same group of schoolchildren, now in the 19-24 age bracket, shows more than half – 56 per cent – had experienced a psychiatric disorder at some stage; almost 20 per cent of those were within the previous month.

The first survey of its kind in the Republic, both stages of it were done through standardised, diagnostic interviews conducted face to face by psychiatrists and/or psychologists. Although the sample is representative of the population as a whole in north Dublin, the findings can’t be applied nationally.

“It’s a good start,” says psychiatrist Dr Michelle Harley, the paper’s lead author, about the results. “We rely on data from other countries but it is not necessarily the same: there are things that are unique about Ireland. We need our own figures.”

The findings are important, she says, because they show high levels of mental disorders. Mood disorders are most prevalent (28.4 per cent), followed by anxiety disorders (27.1 per cent).

It also exposes higher rates of binge drinking (defined here as six or more standard drinks on one occasion at least once a week) than in other UK and Irish studies, with three-quarters of those interviewed having done this.

“I think the drinking culture is possibly part of the reason there is a higher rate of mental health problems in young people as well,” says Harley who, personally, was surprised that the abuse of some other drugs was not far behind. Almost 65 per cent had used cannabis at some point, and more than a quarter had used it within the past month.

“Beyond that, there was a subgroup using cocaine, speed and mushrooms. The study quantified when they started: they’re young and getting into all sorts of stuff.”

The second phase of Challenging Times started just as the recession was beginning in 2008 and another paper in the journal, of which the lead author is Emmet Power, explores the link between mental health and economic inactivity. The findings suggest both cause and effect.

Of those surveyed who were not in education, employment or training (referred to as Neet), 64 per cent had met criteria for a mental disorder during childhood or adolescence.

Yet, independent of mental health history, this Neet group had a sevenfold increased risk of suicidal ideation.

As the survey captured such rich data, says Harley, there is plenty more research to be done: looking, for example, at risk and resilience factors and identifying which children overcame their difficulties from adolescence to adulthood. Another research group is looking at sexual orientation, “which is still a significant risk factor, in Ireland anyway, for mental health problems”, she adds.

Official annual theme

The dedication of the current issue of the College of Psychiatry’s quarterly journal to youth mental health follows the adoption of this topic as the college’s official annual theme in 2013. It brings together people who are doing relevant research in the area, to try to highlight what is being done here to progress mental health, says Coughlan, who is a clinical research fellow with the Royal College of Surgeons in Ireland.

"Ireland is considered one of the leaders, believe it or not, in the movement of youth mental health," she tells The Irish Times. Australia and then Ireland are at the forefront of advocating for youth- friendly services, followed by the UK and, latterly, Canada.

However, despite being well regarded, “we just haven’t been able to translate that into the services we want on the ground”, says Coughlan, who is chairwoman of the Association for Child and Adolescent Mental Health’s special interest group in youth mental health.

The 16-18 age group is a particular concern as they are caught between the child and adolescent services, which historically stopped at age 16, and the adult services. Even when adolescent services continue to see someone up to 18, there is “no nice, seamless transfer to adult services”, she points out.

“They have to be referred in as a whole new process to adult services. It is really problematic that transitional phase – along with the fact that it is the peak of onset.”

Although Headstrong, the National Centre for Youth Mental Health, and its regional Jigsaw initiative offer valuable, youth- friendly support, it would be much more beneficial if they were closely linked, in a co-operative, co-location arrangement, to specialist services – as in Australia’s Headspace model, she argues.

Currently when Headstrong and Jigsaw need to guide people towards specialists, “those young people are still going to the same old health centres, sitting with the people who are 60 and 70 and have been using the services for years”, she says.

“What we don’t have in Ireland is a service that can straddle the continuum from support to really specialist [treatment]: psychiatry, clinical psychology, occupational therapy and other allied professions.”

‘Catastrophic’

This lack of any formal, high-level strategy overseeing and co-ordinating investment in youth mental health is “catastrophic”, she says. “We are not using what is available to us as effectively as we could.”

Although the 2006 mental health blueprint, A Vision for Change, recommended a gradual increase in spending on this area to 8.24 per cent of the overall health budget (it's about 12 per cent in the UK), it was down to nearly 5 per cent by 2013, according to the College of Psychiatry.

The setting up of lots of small charities working in, say, the area of suicide prevention has been an understandable, community response to increasingly recognised problems.

But, Coughlan asks, “Are we making the best use of the resources by giving bits and pieces to dozens and dozens and dozens of charities and NGOs?”

The economic argument for investment in youth mental health is well proven, as it will reduce the incidence of mental disorders persisting through adulthood.

In extreme cases, such as psychosis and suicide, it is not just the cost to the State of the care of the individual that have to be taken into account, she explains.

Other costs, such as lost productivity among grieving family members and further ripple effects, add to the economic burden of mental health on the State.

While both she and Harley acknowledge that progress has been made in the past decade, there is still a lot more to do to protect the mental health of young people.

The March edition of the Irish Journal of Psychological Medicine: Special Issue – Youth Mental Health is now available. See: iti.ms/1zuY4he