Intended for healthcare professionals

Head To Head

Should youth mental health become a specialty in its own right? No

BMJ 2009; 339 doi: (Published 26 August 2009) Cite this as: BMJ 2009;339:b3371
  1. Peter Birleson, adjunct professor and director
  1. 1Integrated Mental Health Program, Royal Children’s Hospital, Parkville Victoria 3052, Australia
  1. peter.birleson{at}

    Mental illness often develops in adolescence and young adulthood. Patrick McGorry (doi:10.1136/bmj.b3373) believes the best way to ensure early treatment is to have dedicated services, but Peter Birleson argues that integration with existing systems is more important

    Proponents of a youth model for specialist mental health services claim that it will improve access to services early in the course of an illness. But replacing current specialist mental health services for 0-17 year olds (paediatric psychiatry) and 18-64 year olds (adult psychiatry) with three subspecialties for 0-11 year olds, 12-24 year olds, and 26-64 year olds1 ignores current models of service planning,2 3 reduces the critical mass of child and adolescent mental health services needed to adopt evidence based practice,.4 5 and complicates mental health services. It fragments current service links and is likely to increase transition problems.

    Psychotic disorders, such as schizophrenia or bipolar disorder, have their peak incidence at 21 and 22 years respectively,6 and substance use disorder peaks at 21-23 years.7 But psychotic disorders are not exclusive to youth and occur in both childhood and maturity. Although many psychotic episodes do start …

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