Moving beyond stepped care to staged care using a novel, technology‐enabled care model for youth mental health

Abstract

This model of care emphasises not only early access to assessment across a number of clinical and functional domains but also rapid and ongoing provision of stage-appropriate interventions A ustralia can rightly claim to lead the world in mental health awareness, especially for the mental health and wellbeing of young people. 1 However, despite the development of designated primary care-style services (eg, headspace), 1 we still do not deliver effective care, early in the course of illness, to most young people with anxiety, depression, or alcohol or other substance misuse. 2 Even when we do deliver care, the longer term functional outcomes are often disappointing. 3 The consequences of this failure remain largepersonally, socially and economically. 4While the Morrison Government is committed to expanding youth services and reducing youth suicide, 5 practical questions remain to be answered. Specifically, do we have: a viable clinical model; the necessary multidisciplinary workforce and team-based funding structures; health system capability and integration of key acute and ongoing service settings; regional planning, governance and service commissioning capability; and health information technology infrastructure to enable personal and system-level data tracking and integration?All of these elements are necessary for the delivery of the highly personalised and measurement-based care model we propose in the Supplement that accompanies this issue of the MJA. 6 Although this novel, technology-enabled care model for youth mental health has many evidence-based components and has been co-designed with young people and their families, as seen in the Project Synergy trials, 7 it remains to be demonstrated whether, compared with either existing child and adolescent or adult service models, it results in improved clinical and social outcomes. If this youth model of care is more effective, the challenge will be to deliver it at sufficient scale to have real population-level impacts in regions where specialist clinics are not available, so that it connects with populations who are at high risk or traditionally under-represented in care.Substantive clinical innovations over the past decade have led to the concept of highly personalised and measurement-based care (Supporting Information). The highly personalised component is achieved through the integration of three core concepts: assessing multidimensional domains of morbidity and function; clinical staging; and mapping pathophysiological pathways across development, from childhood, through adolescence and into early adulthood, as well as illness trajectories.The measurement-based care component 8 is achieved by linking individual care to the use of more sophisticated real-time health information technologies that can enhance immediate and continuous clinical decision-making (see Chapter 5 of the accompanying Supplement). 6The first of these innovations is the development of a more sophisticated, multidimensional approach to clinical and functional assessment. 9 This approa...

Dynamics of Mental Health and Healthcare Use among Children and Young Adults

“…The Better Access initiative to include telehealth consultations is promising (Department of Health 2019), but increased non‐telehealth fee‐for‐service payments are unlikely to solve access issues for children and young people in disadvantaged areas where service provision is low. More emphasis must be placed on lowering the barriers to seek help and improving access through supply‐side factors such as online options for those with mild and moderate conditions; the use of schools as potential gateways to access treatment (Productivity Commission 2020); and proposed new models such as technology‐enabled staged care (Hickie 2019); these should be trialled and robustly evaluated before being rolled out. As children turn to their friends and families for help, measures to increase mental health literacy among parents and students in general may also be helpful.…”

Informing the Future of Integrated Digital and Clinical Mental Health Care: Synthesis of the Outcomes From Project Synergy

“…Over the past 20 years, our research group has actively advocated for the use of technology to drive enhanced mental health care, and broader system reform, in Australia [4][5][6][7][8]. Although there is a growing evidence base supporting the use of digital technologies, the integration of digital solutions in mental health services remains relatively rare.…”

“…With the stage set by the population-level modeling outcomes, Project Synergy has now delivered critical outcomes regarding the practicalities of designing, implementing, and evaluating digital mental health solutions (Figure 7 [4,6,15,[19][20]22,[27][28]31,[36][37][38]43,[53][54][55][56][57][58][59]). These outputs are critical pieces needed to inform delivery of effective technology-enabled and coordinated mental health care, as called for by the Productivity Commission [3] and the World Economic Forum [60].…”

“…This has the capacity to firmly establish Australia as a leader in the delivery of digital mental health care. [4,6,15,[19][20]22,[27][28]31,[36][37][38]43,[53][54][55][56][57][58][59]].…”

Protocol for a young adult mental health (Uspace) cohort: personalising multidimensional care in young people admitted to hospital

“…Open access transdiagnostic, person-centred model of care emphasises early access to personalised care through a comprehensive multidimensional assessment of various clinical and functional domains, 5 including social and occupational functioning, self-harm and suicide risk, alcohol and substance misuse, physical health, clinical severity and stage (stage 1a (non-specific symptoms) to stage 4 (severe, persistent and unremitting illness)) 6 7 and illness subtypes (psychosis, anxious depression, bipolar spectrum). It also links with putative pathophysiological pathways (neurodevelopmental, hyperarousal, circadian) as well as individual illness trajectories.…”