The mental health of young people: a new frontier in the health and social policy of the 21st century

One of the greatest paradoxes of the modern world is that while material well-being and physical health have dramatically improved, the mental health of young people in transition from childhood to adulthood has been steadily declining, and this from a low base. One of the failures of the field so far is not to have appreciated that the timing and pattern of mental ill-health impacts so strongly on young people who, on the threshold of adult life, have the most to lose. Society as a whole also loses, in terms of reduced human capital, ‘mental wealth’ and productivity in the broadest sense. A recent New Zealand study estimated that up to 50% of young people in this transition period will experience at least one diagnosable episode of mental ill health with proportionate negative impact on earning potential, educational outcomes and social integration at age 30. The scene for this erosion of life chances is often set in childhood, but more commonly, it takes the ever changing climate of adolescence and emerging adulthood to release the variety of clinical phenotypes we recognise as clinicians, the incidence of which surges through adolescence and peaks between 18 and 25 years. What we call ‘disorders’ are experienced first by young people and their families as emotional distress, attempts to cope or deny, behavioural disturbances and all too often collateral damage such as vocational failure, substance abuse, deliberate self-harm and offending behaviour. Influenced by stigma and the orthodox view (see Eckersley this issue) that the health of young people has never been better, many people make the mistake of assuming that, because emotional distress and damaging behaviours are common in young people, this is ‘normal’ and largely transient, and to intervene would be unnecessary or even harmful. This is dangerous thinking. It confuses being common with being benign; a serious error with often fatal consequences. Malaria is common in many developing countries, but hardly benign. Young people with the highest incidence and prevalence of mental ill health receive the least help to overcome these threats to their survival, well-being and contribution to others. So far, we have made only desultory efforts to understand what is behind this rising tide of mental ill health and try to turn it back. The sophistication that is evident in so many areas of human endeavour, from media and communications, finance, engineering and complex medical procedures is still lacking in the mental health field. Mental health care has barely emerged from the age of steam and is struggling to adapt to the 21st century. It lags behind physical health care in investment, access, quality, leadership, community support and political will. Yet, the study of mental health and mental ill health is a broad and fascinating domain with so many levels and vistas to explore and link up. One of the most exciting developments in mental health in recent times, one which seeks to move the field to 21st century mindsets and standards to join all the other fields of human endeavour, is the wave of interest in early intervention and the related youth mental health paradigm. For this reason, the First International Youth Mental Health Conference, which was held in Melbourne on 29–30 July 2010, could not have occurred at a better time. Following on from a highly successful international youth mental health summit held in Killarney in Ireland in May 2010, the goal was to lay a foundation for an international process to create a new professional field which would weave together a variety of disciplines and perspectives from sociology, psychology, psychiatry, addiction, nursing, neuroscience, economics, public health and social policy, education to justice. Hosted by headspace and sponsored by Orygen Youth Health, Bupa Australia, the Australian General Practice Network, beyondblue, the Victorian Health Promotion Foundation and St John of God; the conference was an absolute revelation. While 400 delegates were expected, more than 1000 turned up to share in a unique experience. Even hard-bitten conference attendees were overwhelmed with the breadth, depth and inspiration that flowed through the event. No doubt this was in large part because of the influence that young people themselves exerted during the event through Early Intervention in Psychiatry 2011; 5 (Suppl. 1): 1–3 doi:10.1111/j.1751-7893.2010.00231.x First Impact Factor released in June 2010 and now listed in MEDLINE!