Early Intervention in Mental Health Care: Benefits and Challenges

In summary

• Current treatment strategies in mental health highlight the importance of early intervention
• Because mental illness typically emerges early in life, adolescence and young adulthood are critical periods for intervention
• Where available, early intervention services have proven to be highly accessible to young people and result in outcomes that are positive for the prevention or delay of onset of mental health conditions
• Despite progress made in the mental health field, there remains a need to continue developing youth mental health care models and early intervention strategies, particularly for non-psychotic disorders

 

Mental health today: Why do we need a transformation in mental health care?

Approximately 1 billion people worldwide—nearly one in eight—live with a mental health disorder.¹ Symptoms of mental health illness typically emerge early in life – half of lifetime cases of mental health disorders are reported to begin by age 14² and 75% by the age of 25.³ Globally, an estimated one in seven 10–19-year-olds (approximately 166 million adolescents) are thought to be living with a mental health condition,⁴ and the development of mental illness is increasingly being identified in children preschool-aged and younger.⁵ Suicide is the fourth leading cause of death in individuals aged 15–29,⁶ and the prevalence and severity of mental health illnesses among young people have sharply increased since March 2020.² Early signs of distress in young people are often overlooked or regarded as not worrisome enough to warrant referral to specialized services.⁵ As a result, the current mental health care system is reactive, resulting in referral and diagnosis once problems are well established.⁵ Youth with untreated or undiagnosed mental health conditions are more likely to experience family dysfunction, poor school performance, incarceration, substance use disorder, unemployment, and death by suicide.² 

In 2022, the World Health Organization (WHO) published the WHO’s World Mental Health Report: Transforming Mental Health for All, in which they highlight an urgent need to transform mental health care services worldwide.⁷ One step toward this transformation is through the implementation of early intervention strategies to support adolescents and young adults.

The case for health service reform and early intervention strategies

Despite the pre-adult onset of many mental health conditions, adolescents are less likely than any other age group to access mental health services.³  This underutilization is alarming given that early intervention can slow the progression of mental health illnesses and reduce the associated mortality and long-term morbidity.³ Conversely, when help is sought, young people with emerging mental illness may not meet adult diagnostic criteria, leading to insufficient access to care and missed opportunities for early intervention.³

Timing of intervention is critical. Advances in developmental and child psychiatry have determined that adverse childhood experiences are associated with most adult mental health conditions.⁵ Therefore, the solution to the ever-growing and increasingly disabling global adult mental health problem may lie, at least in part, in efforts to improve mental health earlier in the lifespan.⁵ It is during this time of developmental malleability that opportunities to correct mental well-being will be most effective.⁵

Youth-specific healthcare models that promote multidisciplinary care integrated within primary care settings and aimed at prevention and early intervention are needed.^3,5 These models should prioritize healthy family environments as a means of providing the best opportunity for mental well-being across the lifespan – this includes supporting parent–child and family relationships, parents’ emotional and behavioral health, and family routines.⁵

Early intervention in adolescents: What evidence do we have for its success?

The first early intervention models – focused on helping individuals with psychotic disorders – were successful and have paved the way for international change.^3,8 Newer models have expanded their areas of interest from psychotic disorders to mood, personality, eating, and substance use disorders.^3,8 As a result, multidisciplinary and integrated healthcare services for young people with mental health difficulties and their families are becoming easier to access.⁸

In 2006, a government-funded initiative in Australia led to the creation of Headspace, a multidisciplinary and integrated service providing early intervention and prevention for 12–25-year-olds with emerging mental health concerns.³  The success of Headspace has flowed to other parts of the world, with the United Kingdom, Ireland, Canada, the United States, Europe, and Asia having adopted similar models.³

While refinement and expansion of early intervention services are ongoing, the progress made thus far has begun to fill a critical gap in providing multidisciplinary, stigma-free mental health care services tailored towards young people.^3,8

Early intervention in adolescents: Future directions

Current evidence is highly encouraging and supports the widespread implementation of early intervention for psychosis. Where available, early intervention services for non-psychotic disorders, such as mood and personality disorders, have proven to be highly accessible to young people and result in outcomes that are positive for the prevention or delay of onset of mental health conditions.³ For example, evidence supports the use of early intervention strategies in both depression and bipolar disorder.³ However, early intervention for non-psychotic disorders is still gaining traction, and progress is needed in this area. By determining the most effective interventions to enhance functional outcomes and provide opportunities for a productive future, we can more fully realize the potential of early intervention for adolescents with poor mental health.

Further reading

• Buka SL, et al. Pediatrics 2022;149:e2021053509L. The Family is the Patient: Promoting Early Childhood Mental Health in Pediatric Care.
  An article from the American Academy of Pediatrics (AAP) describing six core principles of early childhood mental health, five novel intervention approaches, and new options for financing a service organization that could form the basis of a transformative system of mental health development.
• Hickie IB, et al. Med J Aust 2019;211(Suppl. 9):S3–S46. Right care, first time: a highly personalised and measurement-based care model to manage youth mental health.
  An article outlining a highly personalized, measurement-based care model for managing youth mental health.

ACCESS, Adolescent/young adult Connections to Community-driven Early Strengths-based and Stigma-free services; MCPAP, Massachusetts Child Psychiatry Access Program.
*List is not all-inclusive.

Cite this article as Early Intervention in Mental Health Care Challenges. Connecting Psychiatry. Published May 2023. Accessed [month day, year]. [URL]

SC-US-75154

SC-CRP-13430

April 2023