Following a successful child and adolescent mental health summit in Killarney, Aoife Connors looks towards the endorsement of a landmark declaration at the first International Youth Mental Health Conference in Australia next month
The first international declaration of youth mental health was written and presented at an international youth summit in Killarney last month (May 19). Organised by the Association for Child and Adolescent Mental Health (ACAMH) and a group of clinicians working with young people with mental health issues, the summit saw more than 80 experts travelling from Canada, Ireland, Australia, the Netherlands, Wales, England, New Zealand and the US to attend.
Among the key people involved in the declaration was Prof Patrick McGorry, a member of the international youth mental health steering group and 2010 Australian of the Year, and a world leader in youth mental health.
Also attending were: Prof Simon Davidson, Chief of Psychiatry and Chief of Staff at the Children’s Hospital Eastern Ontario; Dr Paddy Power, St Patrick’s Hospital; and Dr Tony Bates, CEO of Headstrong.
Prof Fiona McNicholas, Consultant Child and Adol-escent Psychiatrist at the Lucena Clinic, said: “We’re leading the way by having a lot of clinicians, service users, scholars, practitioners and managers from all around the world in Killarney, with an opportunity to get this body of people talking about youth mental health.”
The conference focused on young people between the ages of 12 and 25 with mental health illnesses and on forming an agreement to finalise the international declaration on youth mental health. “The reason for having an international declaration on early intervention and youth mental health is to focus public opinion on a number of issues like access to services, early intervention, prevention and treatment,” Prof McNicholas told Irish Medical Times.
Values and goals
In an interview before the event, Prof McGorry — who was a visiting professor at UCD last year — told IMT that the group was aiming to establish an international collaboration to promote the development of the youth mental health field and new knowledge and service reform. Speaking at the conference on the logic and evidence supporting this reform direction, which is already under way in Australia, Prof McGorry said he wanted to see a statement of ‘principles, values and goals for youth mental health’ in the declaration.
“The next step is endorsement of the declaration at the first International Youth Mental Health Conference in Melbourne, which takes place from July 29 to 30, 2010.”
The international declaration will detail the best youth mental health services available internationally, such as those successful models in New Zealand, the UK and Australia, and what could be implemented in Ireland. Prof McGorry said the Irish mental health service lacked many things. “We need a stigma free front-end, like Jigsaw, and specialised youth mental health professionals with structures similar to the Orygen Youth Health Centre in Australia, which provides early intervention treatment programmes for children and adolescents with mental health illnesses.”
However, the Irish mental health service was seriously underfunded, he added. “There is complacency that the paediatric CAMHS model is okay for mental health. It is not! We need a strong youth mental health stream of care.”
Young people throughout the country attended the one day summit in Killarney, with many having made submissions and expressed their own views on what the declaration should include.
The international declaration will raise awareness, with countries pledging to create community awareness about mental health issues in young people. By doing so, it can help reduce the stigma surrounding mental illnesses and improve public knowledge about what might constitute depression, psychosis or eating disorders.
Experts agree that lessening this stigma is possibly one of the most difficult aspects of improving mental health. Prof McNicholas believes you can achieve this by organising a lot of public education lectures, talking about the issues within the media, and by having mental illness portrayed in a sensitive and fair way on TV and radio programmes. Encouraging celebrities with a mental health illness to go public with their condition can also reduce the stigma.
Illness origins
Prof McNicholas believes a key issue is the fact that the majority of adult mental health illnesses actually have their origins in childhood. “Almost 50 per cent of adult mental illness results from symptoms present before the age of 15, and if you look at 20-year-olds, three quarters of Irish adult mental health problems would have been present in young people before the age of 20 years.”
Essentially, if the signs of mental health illness in young people can be identified early, intervention can also begin early. “We know that the earlier you intervene in these illnesses, the less likely you are to have secondary impairments. You might even reduce the possibility of recurrence for some of the illnesses like psychotic episodes or depressive stages, so early intervention is very important,” she said.
Early intervention in psychosis was very successful at shifting the negative attitude to the condition and inspiring hopeful treatment that makes a difference for the individual, said Prof McNicholas, adding that we all need to look after our mental health much better to prevent mental illness. “Taking physical health seriously by exercising — running, going to the gym — and looking after our diet is something we often try to improve, but we should have the same emphasis on our mental health. Be aware of your emotions and how you regulate and monitor them. Be mindful when experiencing a lot of emotions that are beginning to affect relationships or family life and focus on ways to change that,” Prof McNicholas suggested.
The whole premise of using cognitive behavioural therapy was that “how we think actually influences how we feel, and how we behave also has a direct impact on how we feel”, she said. People needed to change their thinking style to become more positive and more rooted in actual facts, not worries or fears. “Our physical and mental health are intertwined — one influences the other in a positive or negative way.”
Evidence based
As research on mental health services and treatments develops, it is clear that Ireland should be basing treatments on ‘evidence–based approaches’, according to Prof McNicholas. “We should have a national standard that should be available to all who access the service. It is shifting from an illness model to a recovery model and positive mental health.”
Ms Sarah Buckley is a Consultant Child and Adoles-cent Psychologist at St Patrick’s Hospital and Chair of the ACAMH Special Interest Group. She is well aware of the need for the international declaration on youth mental health. “There are many gaps in mental health services here, but Ireland is not unusual. For young people between 16-18 years, it is very hard to go from child to adult services at 16 years.”
She told Irish Medical Times that often young adults feel the service does not meet their needs, especially if they are in a clinic with 65-year-olds. She believes young people who might have a difficulty with the stigma of going into a mental health clinic should have accessible youth-friendly services.
“At the moment, child or adolescent services stop at 16 years. Adolescents move into adult services but there needs to be communication between the two, so it becomes a seamless transition from adolescence into adulthood, because its such an important and vulnerable time,” the psychologist said.
St Patrick’s Hospital now cares for adolescents aged up to 18 years. “We’ve hired a new consultant, Dr Paddy Power, to look after the 18- to 26-year-olds. St Patrick’s is taking on the youth model; we are valuing young people and trying to make the transition from child to adult services a natural one,” Buckley concluded.
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