Personalised Mental Health Care for Young People: Using Past Outcomes to Build Future Solutions

Abstract

Mental health disorders present one of the most serious public health challenges we face in the 21st century. Their prevalence, early age of onset and chronicity contribute to the substantial burden and secondary risks associated with these disorders. They tend to emerge during adolescence and young adulthood, a period characterised by major physical and social change, and so the effects of these disorders can often have long-term consequences on the adult lives of young people. Previously young people have had poor access to health services that address their needs, however the development of youth-focused health services has been a critical step forward to addressing this gap, providing better access to mental health care for adolescents and young adults. The nature of mental health disorders among young people, however, means that there are still major challenges in providing quality mental health care that addresses the broad range of health, social and functional needs of young people. The overall aim of this thesis was to examine the long-term outcomes of young people attending early intervention youth mental health services to inform the development and delivery of personalised mental health care that address the needs of young people. The first two studies are empirical papers that generate new knowledge with regard to the real-world long-term health, social and economic outcomes of help-seeking young people who attend an early intervention mental health service. This outcome data was used to delineate which young people are particularly at risk for worse clinical and functional outcomes and guide the development of new approaches that aim to improve the delivery of youth mental health care. A third empirical paper assessed the role of a technology-enabled clinical protocol to identify and respond to suicidal thoughts and behaviours at service entry. This study has been critical to the development of real-world service provisions that address this specific health care need with further implications for broader use. Finally, a systematic review was conducted which collates the findings from over 130 studies to determine the neurobiological correlates of these broader health, social and economic outcomes to inform future clinical research and the integration of further assessment into the delivery of youth mental health care. The overall findings of this thesis are fourfold. The first is that there is still work to be done to ensure young people are receiving mental health care earlier in the course of these illnesses and prior to the emergence of significant problems. Further research is still needed in this area to determine which strategies are most effective for improving help-seeking behaviours and promoting early intervention. The second is that health service strategies should be in place to identify and respond to individual health and social needs young people present with, particularly those that are associated with poorer long-term outcomes, such as substantial functional impairment and suicidal behaviours. The third is that early identification followed by current standard care provisions do not appear to inevitably result in improved outcomes. Instead, it is clear that the development and evaluation of specific, integrated care packages may be needed to reduce the morbidity and mortality due to early-onset major mental health disorders. Finally, there is a role for new technologies in mental health reform and the delivery of personalised mental health care, and future studies should focus on implementation strategies that facilitate the evaluation of these technologies in real world settings.