Hickie Ian B, Rosenberg Sebastian, Carpenter Joanne S, Crouse Jacob J, Hamilton Blake, Hermens Daniel, Guastella Adam, Leweke Markus, Capon William, Scott Elizabeth M, Iorfino Frank
Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.
Health Research Institute, University of Canberra, Bruce, ACT, Australia.
Aust N Z J Psychiatry. 2025 Feb;59(2):99-108. doi: 10.1177/00048674241297542.
Globally, youth mental health services are evolving, with Australia's services presented as a leading exemplar. services were designed as enhanced primary care-based entities and were expected to collaborate with local acute, and specialist clinical and psychosocial services. The lack of large-scale health services trials necessitates understanding their impact through systematic monitoring and evaluation. This paper compares data from differing sources that describe the demographic and clinical features, and functional outcomes, of young people presenting to various services. National reports that care is provided largely to youth with transient distress, minimal clinical disorders, suicidality or comorbidities and limited functional impairment. Almost 50% of clients are reported to have no significant psychological symptoms or risk factors, and less than 30% to have a clinical disorder. Consequently, 36% receive only a single session of care and the median number of clinical sessions provided is three. By contrast, empirically derived estimates, utilising data from an academic centre and its affiliated centres, other independent agencies and more refined analyses of national data variously portray 50-60% of youth as presenting with at least moderate clinical complexity (including at least 20% with high complexity), and with another 27% requiring active clinical intervention. Together, these data suggest approximately 75% of attendees require substantive clinical care. Clinical outcomes data from all sources indicate limited impacts on functional outcomes, with less than a third achieving significant improvement. These data support the original intent of services to focus on equitable access to multidimensional and clinical assessment, evidence-based early interventions for early stages of major anxiety, mood or psychotic disorders. As demand for youth services continues to rise, there is an urgent need to reconfigure our national youth service networks to address the unmet clinical and psychosocial needs of youth presenting in the early stages of major mental disorders.
在全球范围内，青少年心理健康服务正在不断发展，澳大利亚的服务堪称领先典范。这些服务被设计为强化的基层医疗实体，并有望与当地的急症、专科临床及心理社会服务机构开展协作。由于缺乏大规模的健康服务试验，有必要通过系统监测和评估来了解其影响。本文比较了来自不同来源的数据，这些数据描述了前往各类服务机构的年轻人的人口统计学和临床特征以及功能结局。国家报告显示，所提供的护理主要针对有短暂困扰、临床疾病轻微、有自杀倾向或共病情况且功能损害有限的青少年。据报告，近50%的服务对象没有明显的心理症状或风险因素，不到30%的人患有临床疾病。因此，36%的人只接受了一次护理，所提供的临床护理疗程中位数为三次。相比之下，利用学术中心及其附属中心、其他独立机构的数据以及对国家数据更精细的分析得出的经验性估计表明，50%至60%的青少年至少存在中度临床复杂性（包括至少20%的高度复杂性），另有27%需要积极的临床干预。综合来看，这些数据表明约75%的就诊者需要实质性的临床护理。所有来源的临床结局数据表明，对功能结局的影响有限，不到三分之一的人实现了显著改善。这些数据支持了这些服务最初的意图，即专注于公平获得多维度和临床评估、针对重大焦虑、情绪或精神障碍早期阶段的循证早期干预。随着对青少年服务需求的持续上升，迫切需要重新配置我们的国家青少年服务网络，以满足在重大精神障碍早期阶段就诊的青少年未得到满足的临床和心理社会需求。
