Building the momentum and blueprint for reform in youth

mental health 

Mental disorders have been well characterised as stigma-free and holistic needs-based manner 10
and offer “the chronic diseases of the young” 1 and continue to at least the initial stage of mental
health interventions. disproportionately affect young people worldwide.2 Presentations that
progress or become more complex They are a major contributor to the overall burden of will
require more specialised expertise and increased disease between 10 and 24 years of age, 3
making them efforts, which can be added to existing models of the leading cause of disability
and premature death for care that cater for mild to moderate presentations as this age group.
Societies across the globe are heavily resources and workforces are strengthened. weakened by
mental disorders. Projections suggest To co-create and spread the rationale, research, that by
2030, among the non-communicable diseases, and evidence supporting youth mental health
reform mental illness will pose the greatest threat to worldwide and investment, some global
platforms have been economic growth.4 This threat to economic growth is established. The
International Association for Youth a direct result of the timing in the lifecycle of mental Mental
Health, founded in 2010, has held four global disorders; 75% emerge by 24 years of age, 5 with
the conferences with high levels of youth and community major syndromes, which so often
persist and disable participation in Australia, England, Canada, and across adulthood, emerging
during the transition from Ireland. The International Youth Mental Health puberty to the mid-
20s. This critical developmental Research Network, established in 2015, has held two period is
especially important for completing education, international seminars and produced, with input
from securing employment, and growing social relationships. funding agencies, a set of global
research priorities Consequently, the long-term effects on fulfillment 
in this emergent field. Frayme is a Canadian-based of human potential and productivity
areenormous, initiative aimed at global translation of new research through poor economic and
vocational outcomes.6 This evidence, knowledge, and skills in youth mental health. erosion of so-
called mental wealth7 demands an urgent A close relationship also exists between these networks
response to mental disorders in young people at an and the IEPA: Early Intervention in Mental
Health, individual, societal, and global level. supported by the journal Early Intervention in
Psychiatry, A response is being launched, but from a very low because early intervention
underpins much of the new base. The global treatment gap for mental illness as youth-focused
approaches. In January, 2019, the World a whole is massive.8 It is a particular paradox
that, Economic Forum included youth mental health as a key despite young people bearing the
greatest burden of area within its new mental health programme launched disease onset and
impact, they have the worst access at Davos, Switzerland, and increasing numbers of major to
care of all age groups across the lifespan. Although and emerging research funders are focusing
their efforts most of the world’s young people live in low-income on mental illness at this stage
of life. and middle-income countries, this neglect of youth Although this progress is encouraging,
much greater mental health has been severe even in high-income international engagement and
clarity is needed if this countries. For over a decade, the nature and extent of reform is to
challenge the status quo and overcome this neglect has been recognised and highly promising the
neglect of the mental health of young people. It service innovations have been developed.9 These 
remains unclear whether or not the tide is rising for innovations have emerged primarily in high-
income youth mental disorders, and even where the boundary countries, but they have the
potential to be adapted for of illness onset should be set, though it is universally and informed by
initiatives in low-income and middle-agreed by youth mental health specialists to be too income
settings. This adaptation is possible because high. Speculation and debate abounds in the
literature the innovations have involved a co-designed, youth- and media regarding the causes of
mental ill-health friendly form of enhanced primary care. Primary care in young people; we
urgently need better data and models can absorb the high level of unmet need in a deeper
understanding of contributing factors, including 

Comment 
societal trends. A systematic approach to understanding the evolving epidemiology of youth
mental disorders and how to adequately respond to it is overdue. The Lancet Commission on
Adolescent Health2 provided invaluable epidemiological data, but the Commission reported at a
high level; it did not focus sufficiently on mental ill-health, particularly on its importance as a
major contributor to disease burden especially among the non-communicable diseases. Hence the
task of comprehensively capturing evidence for action in youth mental health has not been
completed from a translational or practical perspective. 
Secondly, the design, structure, and capacity of mental health care is not fit for purpose to realise
the goal of reduced disease burden in young people. The balance between primary and
community health care and specialist and hospital care, and the need for vertical integration,
should be re-examined. The relatively new and underdeveloped subspecialty of child and
adolescent psychiatry has struggled to gain traction globally, and requires fundamental reform.
Adult psychiatry is struggling too to adapt to a post- deinstitutionalisation era in which
expectations and demand have expanded way beyond the clientele of the old asylums, while the
resources and new models to respond to the full range and stages of illness have not materialised
or have even diminished.11,12 The status of mental health within mainstream health care falls well
short of the laudable aspirations that drove integration. This failure can be attributed to stigma
and discrimination, disempowered leadership, serious design flaws linked to a failure to respect
the uniquely different epidemiology of mental 

illness, and a reluctance to be guided by the experience of people with mental illness in creating
therapeutic cultures of care. The status quo is a formidable adversary. How can the challenge of
designing, spreading, and evaluating new models of evidence-informed youth mental health care
be met? The Lancet Commission model might well lend itself to this task, if it could focus on the
translational dimension of the problem. We propose a The Lancet Psychiatry Commission on
youth mental health, with a focus on: (1) identification of the malleable risk factors and
protective factors for the prevention of mental disorders in young people, whether influencing
earlier childhood or the transition to adulthood; and (2) considering a range of new models of
care for young people to identify enablers and barriers influencing their growth and spread.