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Should youth mental health become a specialty in its own right? Yes

BMJ 2009; 339 doi: (Published 26 August 2009) Cite this as: BMJ 2009;339:b3373

A speciality – or an extended family?

Two Australian authors have debated the need for a specialist
psychiatric service ‘tailored’ for ‘the chronic diseases of young people’
aged 15-25.[1] Most of their evidence appears to relate to the problems
of managing chronic psychotic illness during a succession of developmental
changes and life events. In the UK, our New Horizons strategy [2] is
already suggesting ‘a youth mental health service’ (page 40).

Across a very broad spectrum of mental problems, what innovative
services must achieve is both prevention of illness in young people and
early interventions (before an emerging illness becomes chronic). For
example, in the UK we face multi-faceted challenges around young people’s
drinking and the health, education and community impact of so much
alcohol. Within the natural habitats of adolescents, there is an
Ethological need both to prevent disorder and to intervene in ways that
reduce risk of lifelong harm. [3] The key messages for a sustainable
service were identified by the Mental Health Foundation in 2003. [4]
Across all the agencies and professions that would have to collaborate,
joint training ‘on promoting children’s mental health and effective early
intervention work, within schools and community based settings’ (page 10)
would be essential. Following this shared training, ‘formal integrated
linkages’ could be created (page 12) between adolescent psychiatry and
other existing services such as educational psychology, behavioural
support services, education welfare officers and special educational needs

Without a commitment to an “extended family” of services around each
young person, any “speciality” will not be able to produce the whole range
of ‘impacts’ [4] necessary to improve their life chances. Recently a
striking illustration of the costs of attempting the transition to
adulthood when ‘not in education, employment or training’ (NEET) has been
found: 15% of these socially excluded NEETs die within ten years. [5]

1 McGorry P, Birleson P. Should youth mental health become a
speciality in its own right? BMJ 2009; 339: 834-835.

2 Department of Health. New Horizons. Towards a shared vision for
mental health. Consultation. London: DH, 2009.

3 Caan W. Women at risk from alcohol: why we must catch them young.
The Times Education Supplement 2009; 12 June: 30.

4 Mental Health Foundation. Effective Joint Working between Child
and Adolescent Mental Health Services (CAMHS) and Schools. Department for
Education and Skills Research Report 412, 2003. ISBN 1 84185 961 3

5 Vaughan R. Top mandarin: 15% of NEETS die within 10 years. The
Times Education Supplement 2009; 7 August: 1.

Competing interests:
Elected Governor of a mental health trust (CPFT) & Editor of the Journal of Public Mental Health.

Competing interests: No competing interests

11 October 2009
Woody Caan
Professor of Public Health
Department of Child & Family Health, Anglia Ruskin University, Cambridge CB1 1PT.