A leading international psychiatrist believes removing the stigma of depression or substance abuse is vital to improving mental health services for young people. Sylvia Thompson reports
One in three people will have had a mental health problem or a substance use disorder by the age of 25, according to Prof Patrick McGorry, a leading international psychiatrist and director of the Orygen youth mental health service in Melbourne, Australia.
McGorry will be in Dublin next week to address a public forum on youth mental health in University College Dublin, held in association with the newly formed National Centre for Youth Mental Health. He is also the keynote speaker at Adolescent Psychosis: Intervening Early, a conference in St John of God Hospital, Stillorgan, Dublin on Tuesday and Wednesday next.
Deemed to be a world leader in the creation of appropriate mental health services for young people, McGorry has spoken and written extensively on the many fault lines in mental health services including issues such as crude management of emergencies and acute episodes, non-evidence-based use of medications and pessimism among professionals. He is also an energetic advocate of how removing stigma is central to improving services and encouraging young people to seek help in dealing with depression and/or substance abuse earlier.
He says that often young people don't recognise that they have a problem which is confusing for them - particularly for young men.
"It is common to feel shame, weakness, helplessness and an urge to withdraw from others, not only due to stigma but also through the distorting effects of the change in mental state on self-esteem, cognition, energy, judgment and crucially on social relationships," he says.
All of this makes it more difficult to seek help from strangers in a climate where even friends and families often don't discuss such problems openly. GPs, the first port of call for most people, may not be well enough equipped to recognise or deal with such problems either.
"Mental health disorders are the most important single group of disorders in late adolescence and early adulthood," he says. "Seventy-five per cent of mental disorders begin before the age of 25 and two-thirds of the health burden in the 15-24 age range is due to mental disorders," says McGorry.
He adds that nine out of 10 people who die by suicide have suffered from a mental disorder, usually depression. Despite these figures, mental disorders in young people are undiagnosed or under-diagnosed and often receive treatment only when they have become more complex, serious illnesses.
For all these reasons and more, McGorry established the Orygen youth mental health service in Melbourne, Australia.
He explains: "The mental health services in many parts of the world are typically geared towards either children or middle-aged people, and adolescents need a service that they feel comfortable with."
The Orygen centre involves young clients and former clients in key activities of the organisation.
"Typically, adolescents are physically healthy but mentally unhealthy," he says. "They may be suffering from a temporary episode of a panic disorder, a bout of depression resulting from a break-up of a relationship right up to something potentially more serious like an eating disorder, schizophrenia or bipolar disorder.
"The problem is that on the milder end of the spectrum, they don't get any help at all and at the severe end of the spectrum, they end up getting treatment after months, maybe years of delay and may even have experienced a major crisis such as a suicide attempt before they get help."
The Orygen youth mental health service has become the protocol for mental health professionals around the world keen to improve services for young people. There are now approximately 100 centres around the world, following this model of early diagnosis of psychosis.
"It's a big reform movement of the mental health services for young people which aims to cover the full spectrum of problems with multidisciplinary teams dealing with different aspects of the problems," he says.
The multidisciplinary team approach is central to the programme. "Young people need support at various levels including help to re-engage in education or work. Families also need help to deal with the tensions around the problems. "Families are the best support network for young people as the peer network can be quite fragile," he says.
Drugs and alcohol are big risk factors in mental disorders in young people, according to McGorry. And, although he highlights the long-term risk of drugs such as cannabis - nine out of 10 teenagers can cope with it but there will be one in 10 who will develop psychotic symptoms - he points out that alcohol is a much more dangerous drug.
He believes mental disorders and substance use disorders should be treated within the same services. He also believes there is a conspiracy of silence about suicide, perpetrated by the media and supported by professional people who fear copycat suicides.
"There is a way of talking about and reporting on suicide that will not increase copycat suicides. If people are allowed to talk about the huge damage to the family and friendship network that suicide causes, this will be a disincentive to copycat suicides," he says.
One initiative to improve mental health literacy (ie to help people better recognise and seek help for depression and other mental disorders) in Australia is the introduction of mental health first aid courses.
These courses, which teach people how best to deal with emotional and mental distress, are now a compulsory element of training for key professionals (teachers, police, etc) working with young people.
McGorry is also keen to talk up stigma-reducing initiatives such as Beyond Blue in which high-profile sports people and media personalities in Australia have "come out" about their experiences of depression.
"Beyond Blue is a federal-funded agency which has resulted in tremendous changes in attitudes towards depression. Every taxi driver in Australia knows about depression. Ireland could create statutory bodies like this whose role it is to tackle stigma.
"Stigma is based on fear. You've got to confront that fear and you'll see that it isn't that big after all. Every family in every country has experienced mental health or substance use problems in some shape or form," he says.