5381703

Student name: Fumi Burnett  Student number: 5381703   Tutor: Michelle Newcomb

** Saving the youths through early intervention **

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**Artefact** The beginning of this video is a compilation of images typical of young persons in psychological and emotional difficulties. It then changes to graphically explicit photos that are clearly hinting youth suicide and it is quite confronting. What stirs up our perceptions more is the lyrics of the song “Angel” by Sarah MacLachlan. It portrays the deep, dark pit many youths and teenagers struggle to crawl out in their difficult time of adolescence. The contrast of the images of happy and healthy, young people towards the end is almost painful to watch. The message here is to create the world where we see more happy, healthy, and confident young people in our society. But how can we do it?

**Central public health issue** Australia’s youth mental health accounts for almost 50% of the burden of disease for the young people aged 12-25 years (McGorry, 2007). The reason why it is so high is based upon the fact that up to 20% of adolescents suffer from a mental disorder at any given time, and each year average of approximately 400 young people commit suicide (NSW Centre for the Advancement of Adolescent Health, 2008). However, young people are not seeking for help (Rickwood et al, 2007) until the later stage when the condition is already chronic and more disabling (McGorry, 2007). What can be done to stop the young people from falling in to this vicious cycle and having difficulty to get out it?

**Literature review** Surviving the adolescence is not easy. It always has been, as hard as it is now. What is it that the young people going through during that period? McGorry (2007, 2009) says that disorders relating to mood, anxiety, psychotic, personality, eating and substance use are seen in adolescence and early adult life. A survey of more than 10,000 Australian students from prep school (age 4-6) to year 12 (age 17-18) reveals rather sobering results; low levels of social and emotional wellbeing was felt by about 40% of students, 18% were lonely, 20% felt hopeless and depressed for a week and didn’t take part in regular activities for a week, about 32% had trouble controlling their depressed feelings and temper, and 48% had difficulty calming down when they were upset (Eckersley, 2011). They might be seemingly looking okay, but a substantial proportion of them are going through complex and hard-to-handle feelings and emotions. Thus, up to one in four young people in Australia are suffering from a mental health problem, commonly with substance use, depression, or anxiety disorder according to McGorry (2007). This is also a period when the onset of more serious psychosis such as bipolar disorder and schizophrenia usually occurs (McGorry et al, 2007; //Mindframe//, n.d.). When looking at the burden of illness which the youth mental illness can bring about, those in 12-25 age group cost $10.6 billion in 2009 and an additional $20.5 billion was calculated due to the value of the lost wellbeing (disability and premature death) (Access Economics, 2009). Generally only 65% of the Australian population seek for treatment for mental illness. Australian Bureau of Statistics (ABS) (2007) data shows only 25% of 16-24 age group with mental illness receive treatment. Male in this age group is even worse; only 15% of 16-24 age group receive treatment for their mental illness. Hence the percentage of those who are actively seeking for help is not so high. Access Economics (2009) calculated the current treatment for young people aged 12-25 is $62,420 per disability adjusted life year (DALY) averted, which by World Health Organization (WHO)’s measure is classified as cost effective. If this is moved to best practice, dollars per DALY averted is down to $36,399, and this is classified as highly cost effective by WHO. There is an estimate by Andrews et al (2004) that even with 100% best treatment to the population with mental illness, only 40% of the burden of disease is averted. This is where the attention is drawn to the importance of prevention and early intervention. Kessler et al (2005) point out that early and preventative interventions show high potential in reducing the burden of mental illness, particularly with young people. Mental disorders among young people are known for its enduring disability including unsuccessful school life, unstable or impaired employment, and poor family and social functioning, leading to spirals of dysfunction and disadvantage (McGorry, 2007). This is not easy to reverse once they fall into the situation. That is why psychiatric specialists have been claiming the efficacy of early intervention. It is easier and economically effective to tend the young people’s mental disorders at the early stage when it is less complicated and easier to treat, particularly the ones that could lead up to more serious illnesses such as schizophrenia and bipolar disorders. Needless disability and loss of life can be consequently avoided (McGorry, 2011). On the other hand, when treated with a delay, it is known that the outcome of psychosis is poor (McGorry, 2009). Years of efforts by the early intervention clinicians’ lobbying to the government has borne fruit this year– it has successfully secured over $500 million out of the total budget for 2011-2012 of $2.2 billion for mental health for the establishment of facilities for the early intervention service provision (The Treasury, 2011). However it does not necessarily mean that this is a uniformed opinion amongst all the psychiatric specialists. Bosanac et al (2009) argues the evidence of longer term efficacy of the early intervention treatment is equivocal, while admitting the benefit of the treatment for some individuals. Pelosi (2009) questions how to justify the prescription of antipsychotic drugs that cause serious side effects to those who could have been wrongly diagnosed with psychosis; due to the common symptoms between schizophrenia and related illnesses, most patients who enter the specialist programs receive potentially dangerous treatments. There is a figure in Pelosi’s argument that almost 90% of early psychosis treatment recipients, particularly if referred by teachers, college counsellors and families, were receiving unnecessary preventive interventions. Down the track the large proportion of those developing psychosis steadily declines. Those specialists who on the ‘nay’ side of the early intervention are stressing that the study is still premature and there are not enough evidence (Pelosi) for everyone to be “succumb to the allure of boutique early psychosis services” (Bosnac).

**Cultural and social analysis** Let’s look at what is affecting the minds of young people. Countless factors like family changes, media and technology, and population-level personality changes are listed by Eckersley (2011) but he particularly discusses the effect of ‘materialism’ and ‘individualism’ that are linked to many of those cultural changes in Western nations. Both brought the benefit to the society, but also they are pursued so fervently that it caused the shift of goals and values of life from ‘intrinsic’ to ‘extrinsic’. With intrinsic mind, people do things for their own sake; with extrinsic mind, it matters so much that people are meeting the others’ expectation such as status, money, and recognition (Eckersley). The promotion of the false ‘good life’ images and ideals has served the economy. However people evaluate themselves in relation to the world, and this is an unhealthy way of doing it. Thus this affects their wellbeing profoundly. In such a social environment, young people have been feeling the heightened expectations, pressure on individuals, and confusion of autonomy with independence (Eckersley). This is how the emotional/psychological side of the young people’s minds are. Physiologically, it is believed that the human brain development does not stop at adolescence but continues into the 20s (Lebel & Beaulieu, 2011). However, mental health services have been traditionally divided into the ones for under 18s and over 18s just as it fits the physical illnesses. This ended up giving the disjointed management to the recipients and the benefit of services is somewhat lost where the transition happens. The reason young people do not seek help is partly because they do not recognize when their mental health is falling (McGorry, 2011). Bosanac et al (2010) also say that young people and their parents prefer more informal and generic support to the help by psychiatrist, mental health services and antipsychotic medication. Why? “Stigma”. It is the main obstacle to the success of programs to improve mental health (Santorius, 2007). So this is delaying the timing of when the young sufferers start receiving the specialized services. Facilities such as headspace and EPPIC have been successfully providing the very needed form of early intervention services in such a sense. headspace is for young people with mild to moderate mental ill-health and EPPIC for those with emerging serious or complex mental illnesses (McGorry, 2011). These two organizations are closely linked based upon the one-stop-shop idea so when those who are at headspace need more specialized care, they are backed up by EPPIC. Considering the high onset of serious psychosis occurring during the period of adolescence, in addition to the fact that suicide is the highest cause of adult male’s death under the age of 40 (ABS, 2010), prevention and early intervention could be saving many lives that would have run its course otherwise. All the major political parties have endorsed this model for the future of mental health with slight variation of how quickly this will be pushed forward so it will be available to the general population soon (McGorry, 2010).

**Analysis of the artefact and reflection** Quality of MacLachlan’s voice is almost symbolic of young people’s innocence – hauntingly beautiful. So is adolescence, just as shown in the second half of the video. It is something that should be adored and praised. Her clean voice and the forthright choice of words, that are describing the darkness of adolescence, do not seem to make a good balance. That creates certain disturbances in our minds. In this way, this video’s message is successfully delivered by posing a stir. What is implied in the video is the brave façade of the young people as if nothing in their life is wrong. They try so hard but they try it all on their own by distancing them from the surrounding adults because that is part of what adolescence is like. When the society is unprepared for youth mental health, many precious lives slip through our fingers like water or sand. As a parent, I am now painfully aware that we should be more conscious and more informed of youth mental health so we can recognize the signs and manifestation of mental illness issues with young people. Creating the environment in which they can openly talk about their problem is necessary. Education not only for the vulnerable young and adolescent people but also the general public is crucial. Organising and sorting out the health care system that responds well to their needs is important, too. In one way at least mental health seems to have gained the momentum. Famous people like former NSW opposition leader John Brodgen publicly talks about their experiences with depression and suicide attempt. He says in a TV program that he could not have done it a decade ago. This is a crucial and a necessary ‘first’ step. The moment should be seized so a little brighter path could be laid out for those who do not necessarily suffer so much.

**Reference** Access Economics. (2009). //The economic impact of youth mental illness and the cost// //effectiveness of early intervention.// Retrieved October 3, 2011 from http://docs.google.com/viewera=v&q=cache:OqGk0qZGEkIJ:https:accesseconomics.com.au/publicationsreports/getreport.php%3Freport%3D226%26id%3D286+the+economic+impact+of+youth+mental+illness+and+the+cost+effectiveness+of+early+intervention&hl=en&gl=au&pid=bl&srcid=ADGEEShekWU-1sMeI_JmDXqNzXr9_fVFBoXn8OzKNf-i2J22naLlOdS8JyKoTd11Vwc03DQhtQI7bLfbEZy1Zy8aa7MVSTT5OoVcwiiI8WAXg1MxlIi7DJ1Xxn3MFVDNQU1F5AaospkE&sig=AHIEtbQnJx1VlBqOtVFajgXnUMJEHUWWkw

Andrews, G., Issakidis, C., Sanderson, K., Corry, J., & Lapsley, H. (2004). Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders, //The British Journal of Psychiatry,// 184, 526-533. doi: 10.1192/00-000 Australian Bureau of Statistics. (2007). //National Survey of Mental Health and Wellbeing: Summary of Results.// Retrieved from http://www.ausstats.abs.gov.au/Ausstats/subscriber.nsf/0/6AE6DA447F985FC2CA2574EA00122BD6/$File/43260_2007.pdf

Australian Bureau of Statistics. (2010). //Mental Health in Australia: A Snapshot, 2004-05.//Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/1370.0~2010~Chapter~Suicide%20(4.5.4)

Bosanac, P., Patton, G., & Castle, D. (2010). Early intervention in psychotic disorders: faith before facts? //Psychological Medicine, 40,// 353-358. doi: 10.1017/S0033291709990341

Eckersley, R. (2011). Troubled youth: an island of misery in an ocean of happiness, or the tip of an iceberg of suffering? //Early Intervention in Psychiatry, 5// (suppl 1), 6-11. doi: 10.1111/j/1751-7893.2010.00233.x.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Kessler, R., Berglund, Pl, Demler, O., Jin, R., Mrikangas, K., & Walters, E. (2005). Lifetime prevalence and age-of-onset distribution of DSM-IV disorders in the national comorbidity survey replication, //Archives of General Psychiatry, 62// (6), 593-602.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Lebel, C., & Beaulieu, C. (2011). Longitudinal Development of Human Brain Wiring Continues from Childhood into Adulthood, //The Journal of Neuroscience, 31// (30), 10937-10947. <span style="color: #272700; font-family: 'Times New Roman',Times,serif; font-size: 16px;">doi: 10.1523/ JNEUROSCI.5302-10.2011

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">McGorry, P. (2007). The specialist youth mental health model: strengthening the weakest link in the public mental health system. //Medical Journal of Australia, 187//(7), S53-56.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">McGorry, P. (2009). Is early intervention in the major psychiatric disorders justified? //British Medical Journal, 338// (7698), 802-803.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">McGorry, P. (2011). 21st century mental health care: what it looks like and how to achieve it, //Australian Psychiatry, 19// (1). 5-11. doi: 10.3109/10398562.2010.528987

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">McGorry, P., Purcell, R., Hickie. I & Jorm, A. (2007). Investing in youth mental health is a best buy, //Medical Journal of Australia, 187// (7), S5-7.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Mindframe. (n.d.) //Mental Illness Facts.// Mindframe National Media Initiative. Department of Health and Ageing, Australian Government NSW Centre for the Advancement of Adolescent Health. (2008). Understanding adolescents and their health needs. Adolescent Health GP Resource Kit, Practice Points, Section One. Retrieved October 28, 2011 from http://www.caah.chw.edu.au/resources/gpkit/02_Section_1.pdf

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Pelosi, A. (2008). Is early intervention in the major psychiatric disorders justified? No. //British Medical Journal, 337// (a710). 802-803. doi: <span style="color: #272700; font-family: 'Times New Roman',Times,serif; font-size: 16px;">10.1136/bmj.a710

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Rickwood, D., Deane, F., & Wilson, C. (2007). When and how do young people seek professional help for mental health problems? //Medical Journal of Australia, 187// (7), S35-39.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">Sartorius, N. (2007). Stigma and mental health, //the Lancet, 370,// 810-811. doi:10.1016/S0140-6736(07)61245-8.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 16px;">The Treasury. (2011). //Statement 1: Budget Overview.// Australian Government. Retrieved October 17, 2011 from http://cache.treasury.gov.au/budget/2011-12/content/download/bp1_bst1.pdf