Specialized Service Approaches to Maximize Recovery
Specialized mental health services for young people are warranted on several grounds. Young people with emerging illness usually present with complex and evolving patterns of morbidity and fluctuating symptoms, which often means that they do not fit the entry criteria applied in adult services. Even if they are accepted, they often find these services inappropriate and alienating. The complexity and relative nonspecificity of their symptom profiles means that different treatment approaches are required from those for full-threshold illness, with the emphasis being on offering care that is appropriate to the very early stages of illness, is pre-emptive in nature and has a strong preventive and recovery-oriented focus.83,84 This requires a different culture of care to that of the child and adolescent mental health care system, centered as it is on young children in their family environment, or the adult system, which is primarily designed for adults with more established illness. Young people’s unique individual and group identity and their help-seeking needs and behaviors must be central to any care model, which must recognize that developmentally and culturally appropriate approaches are essential for the management of emerging illness in young people. Furthermore, these unique clinical and cultural needs mean that youth mental health services must blur the distinctions between the tiers of primary and specialist care in order to allow a flexible and appropriate response for each young person (and his or her family), depending on his or her own unique needs.84
The available evidence shows that youth-specific services should be provided in an accessible, community-based, nonjudgmental, and nonstigmatizing setting where young people feel comfortable, have a say in how their care is provided, and can feel a sense of trust.84,85 These may be enhanced primary care structures or specialized early intervention services, depending on the young person’s individual needs. These services offer integrated, multidisciplinary mental health care in a stigma-free setting, with strong links to locally available services frequently accessed by young people, such as schools, tertiary training institutions, and educational and vocational support organizations. They aim to reduce the duration of untreated illness, bring about symptomatic recovery, and restore the normal developmental trajectory as soon as possible.
For young people experiencing the early stages of a psychotic illness, these services offer three core functions: (1) early detection, (2) acute care during and immediately following a crisis, and (3) recovery-focused continuing care featuring multimodal interventions to enable a young person to maintain or regain his or her social, academic, and career trajectory during the critical first 2-5 years following the onset of illness.86 The key features of these services are:
- • Easy access to care, ensured by better community awareness of mental health issues, simple referral pathways, close links with local providers, and the “youth-friendliness” of the service and its structure.
- • An integrated biopsychosocial approach to clinical intervention, which takes into account the developmental stage of the young person, as well as the stage of his or her illness. The focus of treatment is not only on the amelioration of distressing symptoms and achieving symptomatic remission, but also strongly emphasizes psychosocial interventions designed to assist the young person in maintaining or regaining his or her normal educational, vocational, and social developmental trajectory to enable a full functional recovery.
- • A high level of partnerships with local service providers to ensure effective and timely pathways into and out of the service, as well as supporting service delivery during the episode of care.87
Long-term follow-up studies from Australia,20 Canada,22 Norway,19 and Denmark16 have shown significantly better clinical and functional outcomes for young people treated within a specialized early psychosis service compared to those who were treated in standard mental health services. Furthermore, these services are more cost-effective than traditional services.88,89 More importantly, they are highly valued by clients and their families.90 It is the culture of hope and optimism, combined with intensive evidence-based biopsychosocial care featuring collaboration with the young person and his or her family, plus the nature of the environment in which it is provided, that is crucial to their success.