Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.
Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia.
Evid Based Ment Health. 2018 Nov;21(4):182-184. doi: 10.1136/ebmental-2018-300060. Epub 2018 Oct 23.
Early intervention is a fundamental principle in health care and the past two decades have seen it belatedly introduced into the field of mental health. This began in psychotic disorders, arguably the least promising place to start. The steady accumulation of scientific evidence for early intervention has eventually overwhelmed the sceptics, transformed thinking in psychotic disorders and created an international wave of service reform. This paradigm shift has paved the way to a more substantial one: early intervention across the full diagnostic spectrum. 75% of mental illnesses emerge before the age of 25 years, and young people bear the major burden for those disorders that threaten the many decades of productive adult life. The paradox is that young people aged between 12 and 25 years have had by far the worst levels of access to mental health care across the whole lifespan. Health services are poorly designed, grossly under-resourced and typically unfriendly to, and untrusted by, young people. Furthermore, until recently there has been a quite striking lack of interest in this transitional age group from clinicians and researchers alike, who had unthinkingly accepted the paediatric-adult split of mainstream medicine without questioning its utility and validity for our field and our young patients. Over the past decade, however, a major shift in momentum has occurred to take early intervention in youth mental health more seriously. Here we discuss the recent advances and evidence supporting an innovative integrated model of youth mental health care and look to the future.
早期干预是医疗保健的基本原则，过去二十年中，该原则已被延迟引入心理健康领域。这始于精神障碍领域，这可能是最不适合开始的领域。越来越多的科学证据表明早期干预是有效的，最终使怀疑者转变了想法，并在精神障碍领域引发了服务改革的国际浪潮。这种范式转变为更实质性的转变铺平了道路：在整个诊断范围内进行早期干预。75%的精神疾病在 25 岁之前出现，年轻人承受着那些威胁到他们未来几十年正常生活的疾病的主要负担。矛盾的是，12 至 25 岁的年轻人在整个生命周期中获得精神卫生保健的机会最差。卫生服务设计不佳，资源严重不足，而且通常对年轻人不友好，也不受年轻人信任。此外，直到最近，临床医生和研究人员都对这个过渡年龄组缺乏相当大的兴趣，他们不假思索地接受了主流医学中的儿科-成人分科，而没有质疑其对我们的领域和我们的年轻患者的实用性和有效性。然而，在过去的十年中，人们对青少年心理健康的早期干预的重视程度发生了重大转变。在这里，我们讨论支持青少年心理健康护理创新综合模式的最新进展和证据，并展望未来。
