McGorry P, Coghill D, Berk M (2023) The Medical Journal of Australia https://doi.org/10.5694/mja2.52047
The mental health of young Australians is rapidly declining.1, 2 The evidence for this is increasingly solid and reflects a worldwide trend.3-7 This steady erosion of our collective mental wealth is not only a human tragedy but an economic one.8 Yet despite this worldwide megatrend, public and media discourse is muffled. Health and social care systems remain asymmetrically focused on physical illness and disability. Despite the erosive effect of mental illness, public pressure and, consequently, the political will for a response, in proportion to the scale and urgency of the crisis, are yet to materialise.
Mental illnesses are the chronic diseases of the young.9 Most adult mental disorders begin during the transition to adulthood.10 This pattern of onset, the extension of developmental transition to adulthood into the mid-twenties, and the evidence that traditional primary care and specialist mental health services were simply not fit for purpose for young people led to innovative reform in youth mental health in Australia and, subsequently, other nations over the past two decades.11 However, although prescient, this has been nowhere near proportional to the scale of the problem.
Youth mental health is a moving target. Over the very period that youth mental health services focused on the 12–25-year-olds’ transition to adulthood began to be assembled, there has been an alarming rise in the incidence and prevalence of mental ill-health in young people.1 The recent National Study of Mental Health and Wellbeing1 revealed that the prevalence of operationally defined mental disorders in 16–24-year-olds rose by 50%, from 26% in 2007 to 39% in 2021. The rise in young women was more marked than in young men, with rates reaching 48%. The HILDA survey of 17 000 households/people confirmed a long term decline in the mental health of this age group.2 This survey also captured the additional impact of the coronavirus disease 2019 (COVID-19) pandemic and its mitigation strategies.2 Similar alarming trends had been identified in many other high income countries well before the COVID-19 pandemic.3, 6, 7, 12 In 2021, in an advisory to the United States President and Congress, the US Surgeon General, responding to similar trends in the US, described the situation as a “youth mental health crisis”.13
The consequences of this rising tide of mental ill-health are profound. We invest heavily to bring young people to the threshold of productive adult life. This nurturing of human potential represents the creation of “mental wealth”.8 Yet this wealth is being squandered. Mental ill-health weakens psychosocial maturation, relationships, educational attainment, workplace culture, and productivity.14 Suicide is the leading cause of death in young people15 and may be rising again post-pandemic.16 Severe mental illness additionally reduces life expectancy by up to 20 years through a combination of premature physical illness and suicide.17 Mental illness due to its timing in the life cycle and the receding tide of infectious and many physical disorders such as cardiovascular disorders is now the number one cause of disability and of chronic disease in Australia.18 Early intervention for potentially disabling illnesses safeguards mental wealth, notably with psychosis (where the return on investment can be as high as 17:1),19 but also anxiety, depression, and attention deficit/hyperactivity disorder (ADHD).20