Imagine there was an illness that struck two out of every five young people in Australia.
That many of those young people were unable to go to school, form friendships or take part in important teenage milestones.
And many were so ill that they desperately needed medical care, but couldn’t get it.
We don’t have to imagine — this is the reality facing young Australians right now.
This stark reality was laid bare in the data from the Australian Bureau of Statistics in July.
The National Mental Health Survey revealed the annual prevalence of mental ill health in 16 to 24-year-olds had surged from 26 per cent in 2007 to 39 per cent in 2020-21 — an unprecedented increase of 50 per cent in 15 years.
Our young people are in serious trouble.
The mental health of young women is declining even more rapidly than young men. These rates of mental illness are double the level of the rest of the Australian adult population.
If such a dramatic increase in prevalence had occurred in cancer, heart disease or any other major illness, it would be the catalyst for urgent and decisive action.
It would be on the front page of newspapers and leading TV news bulletins and the political leadership would be forced to respond.
But not so far.
The danger zone
We know the transition from childhood to adulthood is the peak period for the emergence of mental ill health and the persistent mental illness disorders of adult life.
Half of all health conditions experienced during this developmental period are mental health-related, and the most common cause of death in young people is suicide.
This means that mental illness has become the number one chronic illness throughout life, ahead of arthritis, asthma and diabetes.
And despite being the major cause of disability In Australia, it was an afterthought in the NDIS reform.
As Professor Bobby Duffy from the Policy Institute at Kings College London highlighted in his recent book, Generations, neglect of young people — and especially their mental health — has been a global phenomenon throughout history.
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Limitations to progress
Nevertheless, Australia has been the first high-income country to respond to the issue through successful national programs like headspace, which will soon be in 164 communities. This is a real bipartisan achievement.
Twelve other nations have now followed our lead in constructing a youth-friendly entry channel to the health system, able to respond to milder and short-term conditions.
Such enhanced primary care models represent a base camp for the construction of a full-fledged system of care and produce very good outcomes for early stage and milder conditions.
But the surge in need for care revealed in the ABS survey has overwhelmed this base camp, with major staff losses and growing waitlists.
A new financial model and expanded workforce options are long overdue.
Furthermore, headspace was only ever intended as the first stage of a new multi-level system of youth mental health care.
It urgently needs to be backed up by a second tier capable of effectively responding to the “missing middle” — those young people, the majority in fact, who have more persistent and complex conditions and need team-based, evidence-based intervention to recover and flourish.
These specialized models of care have been designed and carefully tested and are shovel-ready to be scaled up.
The alarming national mental health survey data means this simply cannot be delayed any longer.
The reforms to date are nowhere near the scale and depth required, and they are under extreme stress amplified by the pandemic.
The lack of any sense of urgency to respond contrasts starkly with public health response to COVID itself, and with what would happen if such rises in need were to occur in cancer, asthma or diabetes.
Where is the public voice here? Why is there such limited public mobilization in our own self-interest as a society?
How to turn the tide
The other vital response is a preventive one.
We need to understand much more clearly what trends and risk factors are contributing to this rapid deterioration in the mental health of emerging adults.
There are many candidates, and much speculation, but serious research is needed to determine which are the malleable risk factors that we must target to turn back this tide.
At Orygen, a youth mental health organization, we have expanded the focus of our policy unit to create the Orygen Institute and we are keen to partner with analysts and experts from a range of fields to engage with this challenge over the coming months and years.
The federal Treasurer Jim Chalmers has flagged that he intends the October budget to be a “wellbeing budget”.
According to economist Mariana Mazzucato, this means prioritizing value to society when allocating government expenditure.
The World Economic Forum has demonstrated that mental illness is the dominant health cause of loss of GDP, with double the impact of cancer.
The Productivity Commission revealed the $200 billion annual cost to the economy of the gross underspend in mental health prevention and care.
And a solid body of scientific research confirms the cost-effectiveness and return on investment that effective mental health care for young people delivers.
So this alarming data from the National Mental Health Survey demands that prevention and early intervention for the rising tide of mental ill health in Australia’s young people — on whom our future prosperity depends — be a top priority in the October “wellbeing” budget.
If not now, when?
Patrick McGorry is a Professor of Youth Mental Health at the University of Melbourne and an Executive Director of Orygen Youth Health.