Towards a 21st century system of mental health care - an Australian approach

A 21st century approach to mental health sets targets for reducing the suicide toll and delivers a national suicide prevention strategy on the same scale as the campaign to reduce the road toll. Currently, suicide is the biggest killer of adults up to the age of 40. This is a public health scandal 40 per cent greater in magnitude than the road toll, and is hidden from public view by fear and shame. Let’s bring it out in the open.

Finally, a 21st century approach to mental health features strong investment in research, especially research into novel treatments. Only 3.5 per cent of today’s national health research budget goes to mental health research. This is another serious side effect of stigma and prejudice. Although we do have effective treatments, just like in heart disease, cancer and diabetes we always need to strive for safer and even more effective treatments, not only drug therapies, but novel psychological interventions and social care.

The 21st century approach in practice

Because I am most familiar with it personally, as one example of a 21st century approach that is already available to some people, I am going to present the youth mental health model that is slowly emerging around Australia. This model is built around two closely linked components: headspace, for young people with mild-to-moderate mental health issues; and EPPIC, for young people with emerging serious or complex mental illnesses.

The best way to grasp the 21st century nature of the approach represented by headspace and EPPIC is to think of that other 21st century advance - the iPhone. The breakthrough behind this modern icon is that it simply brings together in a single platform so many of the key tools or ‘applications’ we need to function in the modern world. It is engaging, efficient and hence popular; everyone wants one. headspace and EPPIC are based on the same simple idea - the one stop shop, where the main applications that young people need to protect or recover their mental health can be found.197 There’s a range of applications available: youth-friendly doctors; allied health professionals; drug and alcohol clinicians; educational/vocational expertise; and other back-up programs such as community awareness and outreach. headspace is an enhanced form of primary care based in the heart of the community, providing real expertise without stigma or strings attached.

Young people with more complex or severe forms of mental ill-health need access to additional applications such as hospital or residential care, 24-hour home-based interventions, access to specialist psychiatrists or specialised clinics - hence the need for an integrated back-up system for headspace. This back-up is EPPIC198, which provides more specialised care aimed at maximising recovery from serious mental illnesses, especially the psychotic disorders, during the challenging early years of illness when great therapeutic tenacity and sophisticated scaffolding is essential.

EPPIC has been so successful in promoting early detection and access, and reducing the disability, mortality and costs of potentially serious mental illnesses like schizophrenia, that it has been implemented in hundreds of  locations across the developed world.199 Of course there are other potentially serious disorders such as severe mood disorders, personality disorders, eating disorders and substance use disorders which need to be covered by a back-up system like this in support of headspace and other primary care settings.

Just as the iPhone was made possible by innovative engineering, so too the 21st century model of youth mental health represented by headspace and EPPIC is based on the latest in smart design and consumer-driven understanding of young people and their mental health. So what are these distinctive innovations? Let’s start with the youth focus. Traditionally mental health services have been divided between services for under 18s and over 18s. This makes no sense - we know that the emerging adult phase of 12–25 years is distinct from early childhood or older adulthood. headspace and EPPIC focus on this age range, with a youth-friendly culture that can engage young people, and offer flexible and agile responses.

Early intervention is a key principle, which means as soon as problems emerge they are recognised and responded to. This does not mean early use of medications or an excessively narrow clinical approach, but rather a stepwise pathway of care. Early intervention is an established principle in general medicine, but in mental health it has only recently broken into the mainstream.200 New technologies, especially internet-based information and therapies are a feature, and headspace and EPPIC seek to work in collaborative and complementary partnership with other innovative youth mental health services like ReachOut! and young beyondblue.

Families are welcomed and supported as a key resource in a young person’s recovery. Youth participation is a hallmark - headspace and EPPIC are services that innovate new ways of being accountable to young clients and incorporating their ideas in further service improvements. Finally, headspace and EPPIC are optimistic, with a recovery focus. There is real faith in the resilience of young people while ensuring they still receive the most expert help. The aim is to provide some of the extra scaffolding and specific interventions that so many young people need to lead healthy and fulfilled lives.

First steps towards creating this 21st century approach

All of us - governments, mental health workers and the wider community - have a common interest and important roles to play in creating a 21st century approach to mental health care here in Australia. The federal government’s recent allocation of 1.5 billion of much needed new investment in mental health is an important initial step towards transformational reform. Although the scale of this initial reform investment does not yet fully reflect the level of unmet need, the government’s package is nonetheless well balanced, smartly targeted and lays the groundwork for future reforms. The package contains measures to reduce the burden of mental illness on children and young Australians through prevention and early intervention and to improve the social inclusion and economic participation in the middle and later years of people with severe and enduring mental illness.