New models of care needed to meet increasing youth mental health demand

A dramatic increase in the number of young people accessing mental health care is putting strain on the system, with “urgent changes” required to meet growing demand, according to experts at the University of Sydney.  

The call for action follows a review of clinical data from headspace, the national service for young people experiencing psychological distress. 

The review, led by Professor Ian Hickie and Dr Frank Iorfino from the Brain and Mind Centre, and published in the Australian and New Zealand Journal of Psychiatry, found that headspace is struggling to meet demand, with only around one-third of clients improving after receiving care, and two-thirds either remaining the same or deteriorating. 

Lead author Professor Hickie said: "Nationally, headspace provides an extremely valuable service for young people in psychological distress. But it is a victim of its own success with both demand and the complexity of cases increasing dramatically.  

“This isn’t necessarily about increasing funding but changing the structure of headspace clinics on a national level, so that clients are assessed by senior clinicians at an earlier stage and, where appropriate, put on the right pathways to support their needs.” 

Over the past 20 years, mental health conditions among young people between the ages of 12 and 25 have increased by 50 percent, with the COVID-19 pandemic contributing to a worsening of young people’s mental states. 

To address this, researchers say urgent action is required to improve the models of care provided by headspace to allow clinicians to provide more personalised and effective care. This could include senior clinicians being involved in the diagnosis of young people at an earlier stage; increasing the use of online assessments to determine the severity of a client’s psychological distress; and having a consistent approach to psychological assessments to ensure a national standard.  

For people with complex psychological needs – where an individual has multiple mental health disorders or additional issues such as substance abuse – the report authors also highlight the importance of having clear pathways to a range of medical and psychological services, for example drug, alcohol or housing services.  

The study also highlighted discrepancies in the way that headspace National records the severity of its clients’ needs. For example, a study carried out in 2023 stated that almost half of clients using the headspace National service had no significant symptoms or risk factors, with less than 30 percent having a clinical disorder, such as anxiety or depression.  

In contrast, a separate 2024 study of headspace services suggests that 50 percent of clients were rated as having very high levels of psychological distress and 46 percent had significantly impaired function.  

The researchers say reasons for these inconsistencies in data reporting are not yet fully understood and further research is planned to address this issue in more detail. 

The report’s senior author, Dr Iorfino, said: “We suspect that the inconsistencies could be a result of differences in the outcome measures used to evaluate the success of treatment, or differences in the times between a period of treatment concluding and a follow-up session taking place.  

"If we can reconfigure existing models of care to make them more effective, we can make a huge impact on the quality of care that young people receive and also improve their health outcomes.”   

Research: Hickie, I., Iorfino, F., et al, ‘Novel youth mental health services in Australia: What differences are being reported about the clinical needs of those who attend and the outcomes achieved?’ (Australian and New Zealand Journal Psychiatry, 2024)

DOI: 10.1177/00048674241297542 

Declaration:  Professor Ian Hickie is the Co-Director, Health and Policy at the Brain and Mind Centre (BMC) University of Sydney. The BMC operates an early intervention youth service at Camperdown under contract to headspace. IBH is the Chief Scientific Advisor to, and a 3.2 percent equity shareholder in, Innowell Pty Ltd, which supports the transformation of mental health services internationally through the use of innovative technologies.