From early intervention in psychosis to youth mental health reform: a review of the evolution and transformation of mental health services for young people

  • Ashok Malla
  • Srividya Iyer
  • Patrick McGorry
  • Mary Cannon
  • Helen Coughlan
  • Swaran Singh
  • Peter Jones
  • Ridha Joober
Invited Reviews



The objective of this review is to report on recent developments in youth mental health incorporating all levels of severity of mental disorders encouraged by progress in the field of early intervention in psychotic disorders, research in deficiencies in the current system and social advocacy.


The authors have briefly reviewed the relevant current state of knowledge, challenges and the service and research response across four countries (Australia, Ireland, the UK and Canada) currently active in the youth mental health field.


Here we present information on response to principal challenges associated with improving youth mental services in each country. Australia has developed a model comprised of a distinct front-line youth mental health service (Headspace) to be implemented across the country and initially stimulated by success in early intervention in psychosis; in Ireland, Headstrong has been driven primarily through advocacy and philanthropy resulting in front-line services (Jigsaw) which are being implemented across different jurisdictions; in the UK, a limited regional response has addressed mostly problems with transition from child–adolescent to adult mental health services; and in Canada, a national multi-site research initiative involving transformation of youth mental health services has been launched with public and philanthropic funding, with the expectation that results of this study will inform implementation of a transformed model of service across the country including indigenous peoples.


There is evidence that several countries are now engaged in transformation of youth mental health services and in evaluation of these initiatives.


Youth mental health Service delivery Early intervention 


Compliance with ethical standards

Conflict of interest

None of the authors have any conflict of interest in relation to the material being submitted for publication.


  1. 1.
    McGorry P, Bates T, Birchwood M (2013) Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK. Br J Psychiatry 202(s54):s30–s35CrossRefGoogle Scholar
  2. 2.
    Iyer S, Boksa P, Lal S, Shah J, Marandola G, Jordan G, Doyle M, Joober R, Malla A (2015) Transforming youth mental health: a Canadian perspective. Ir J Psychol Med 32(01):51–60CrossRefGoogle Scholar
  3. 3.
    McGorry PD, Killackey E, Yung A (2008) Early intervention in psychosis: concepts, evidence and future directions. World Psychiatry 7(3):148–156CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Malla AK, Norman R, Joober R (2005) First-episode psychosis, early intervention, and outcome: what have we learned? Can J Psychiatry Rev 50(14):881–891Google Scholar
  5. 5.
    Bertelsen M, Jeppesen P, Petersen L, Thorup A, Øhlenschlæger J, le Quach P, Christensen TØ, Krarup G, Jørgensen P, Nordentoft M (2008) Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Arch Gen Psychiatry 65(7):762–771CrossRefPubMedGoogle Scholar
  6. 6.
    Harvey P, Lepage M, Malla A (2007) Benefits of enriched intervention compared with standard care for patients with recent-onset psychosis: a metaanalytic approach. Can J Psychiatry 52(7):464PubMedGoogle Scholar
  7. 7.
    Craig TK, Garety P, Power P, Rahaman N, Colbert S, Fornells-Ambrojo M, Dunn G (2004) The Lambeth Early Onset (LEO) Team: randomised controlled trial of the effectiveness of specialised care for early psychosis. BMJ 329(7474):1067CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    McGorry PD, Hickie IB, Yung AR, Pantelis C, Jackson HJ (2006) Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Aust N Z J Psychiatry 40(8):616–622CrossRefPubMedGoogle Scholar
  9. 9.
    Yung AR, McGorry PD (1996) The prodromal phase of first-episode psychosis: past and current conceptualizations. Schizophr Bull 22(2):353–370CrossRefPubMedGoogle Scholar
  10. 10.
    McGorry PD (2007) The specialist youth mental health model: strengthening the weakest link in the public mental health system. Med J Aust 187(7):S53–S56PubMedGoogle Scholar
  11. 11.
    Malla A, Jordan G, Joober R, Schmitz N, Norman R, Brown T, Goldberg K, Loohuis H, Vracotas N, Rochford J (2014) A controlled evaluation of a targeted early case detection intervention for reducing delay in treatment of first episode psychosis. Soc Psychiatry Psychiatr Epidemiol 49(11):1711–1718CrossRefPubMedGoogle Scholar
  12. 12.
    Anderson KK, Fuhrer R, Schmitz N, Malla AK (2013) Determinants of negative pathways to care and their impact on service disengagement in first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 48(1):125–136CrossRefPubMedGoogle Scholar
  13. 13.
    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593–602CrossRefPubMedGoogle Scholar
  14. 14.
    Rössler W, Salize HJ, van Os J, Riecher-Rössler A (2005) Size of burden of schizophrenia and psychotic disorders. Eur Neuropsychopharmacol 15(4):399–409CrossRefPubMedGoogle Scholar
  15. 15.
    Wang PS, Berglund P, Olfson M, Pincus HA, Wells KB, Kessler RC (2005) Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):603–613CrossRefPubMedGoogle Scholar
  16. 16.
    Slade T, Johnston A, Oakley Browne MA, Andrews G, Whiteford H (2009) 2007 National survey of mental health and wellbeing: methods and key findings. Aust N Z J Psychiatry 43(7):594–605CrossRefPubMedGoogle Scholar
  17. 17.
    Cheung AH, Dewa CS (2007) Mental health service use among adolescents and young adults with major depressive disorder and suicidality. Can J Psychiatry 52(4):228PubMedGoogle Scholar
  18. 18.
    Singh SP, Paul M, Ford T, Kramer T, Weaver T (2008) Transitions of care from child and adolescent mental health services to adult mental health services (TRACK study): a study of protocols in Greater London. BMC Health Serv Res 8(1):135CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Hovish K, Weaver T, Islam Z, Paul M, Singh SP (2012) Transition experiences of mental health service users, parents, and professionals in the United Kingdom: a qualitative study. Psychiatry Rehabil J 35(3):251CrossRefGoogle Scholar
  20. 20.
    Paul M, Ford T, Kramer T, Islam Z, Harley K, Singh SP (2013) Transfers and transitions between child and adult mental health services. Br J Psychiatry 202(s54):s36–s40CrossRefGoogle Scholar
  21. 21.
    Lamb C, Hall D, Kelvin R, Van Beinum M (2008) Working at the CAMHS/Adult Interface: good practice guidance for the provision of psychiatric services to adolescents/young adults. Royal College of PsychiatristsGoogle Scholar
  22. 22.
    Blum RW, Garell D, Hodgman CH, Jorissen TW, Okinow NA, Orr DP, Slap GB (1993) Transition from child-centered to adult health-care systems for adolescents with chronic conditions: a position paper of the Society for Adolescent Medicine. J Adolesc Health 14(7):570–576CrossRefPubMedGoogle Scholar
  23. 23.
    McDonagh JE, Viner RM (2006) Lost in transition? Between paediatric and adult services: it’s time to improve the transition of adolescents from paediatric to adult services. Br Med J 332(7539):435CrossRefGoogle Scholar
  24. 24.
    McDonagh JE, Kelly DA (2003) Transitioning care of the pediatric recipient to adult caregivers. Pediatr Clin N Am 50(6):1561–1583CrossRefGoogle Scholar
  25. 25.
    McGorry PD, Tanti C, Stokes R, Hickie IB, Carnell K, Littlefield LK, Moran J (2007) Headspace: Australia’s National Youth Mental Health Foundation—where young minds come first. Med J Aust 187(7 Suppl):S68–S70PubMedGoogle Scholar
  26. 26.
    Rickwood DJ, Telford NR, Parker AG, Tanti CJ, McGorry PD (2014) Headspace—Australia’s innovation in youth mental health: who are the clients and why are they presenting. Med J Aust 200(2):1–4CrossRefGoogle Scholar
  27. 27.
    Hughes F, Stavely H, Simpson R, Goldstone S, Pennell K, McGorry P (2014) At the heart of an early psychosis centre: the core components of the 2014 Early Psychosis Prevention and Intervention Centre model for Australian communities. Australas Psychiatry 22:228–234CrossRefPubMedGoogle Scholar
  28. 28.
    Department of Health (2009) New horizons: a shared vision for mental health. Department of Health London, pp 1–94Google Scholar
  29. 29.
    H Government (2011) No health without mental health: a cross-government mental health outcomes strategy for people of all ages. Department of Health London, pp 1–93Google Scholar
  30. 30.
    Meier R, Murphy M, Singh SP, Lamb C (2011) Developing services to improve the quality of life of young people with neurodevelopmental disorders, emotional/neurotic disorders and emerging personality disorder. R Coll Psychiatr Occas Pap 77:1–24Google Scholar
  31. 31.
    Parker C, Clements L, Harbour A, Honigmann J (2011) Transitions in Mental Health Care. Young Minds. United Kingdom National CAMHS Support Service, pp 1–81Google Scholar
  32. 32.
    Brodie I, Goldman R, Clapton J (2011) Mental health service transitions for young people. In: Social care institute for excellence, Research Briefing, pp 1–20Google Scholar
  33. 33.
    Vyas NS, Birchwood M, Singh SP (2015) Youth services: meeting the mental health needs of adolescents. Ir J Psychol Med 32(01):13–19CrossRefGoogle Scholar
  34. 34.
    Coughlan H, Tiedt L, Clarke M, Kelleher I, Tabish J, Molloy C, Harley M, Cannon M (2014) Prevalence of DSM-IV mental disorders, deliberate self-harm and suicidal ideation in early adolescence: an Irish population-based study. J Adolesc 37(1):1–9CrossRefPubMedGoogle Scholar
  35. 35.
    Cannon M, Coughlan H, Clarke M, Harley M, Kelleher I (2013) The Mental Health of Young People in Ireland: a report of the Psychiatric Epidemiology Research across the Lifespan (PERL) Group. Royal College of Surgeons in Ireland, DublinGoogle Scholar
  36. 36.
    Harley M, Connor D, Clarke M, Kelleher I, Coughlan H, Lynch F, Fitzpatrick C, Cannon M (2015) Prevalence of Mental Disorder among young adults in Ireland: a population based study. Ir J Psychol Med 32(01):79–91CrossRefGoogle Scholar
  37. 37.
    Dooley BA, Fitzgerald A (2012) My world survey: National study of youth mental health in Ireland. Headstrong and UCD School of PsychologyGoogle Scholar
  38. 38.
    O’Keeffe L, O’Reilly A, O’Brien G, Buckley R, Illback R (2015) Description and outcome evaluation of Jigsaw: an emergent Irish mental health early intervention programme for young people. Ir J Psychol Med 32(01):71–77CrossRefGoogle Scholar
  39. 39.
    Kutcher S, Davidson S, Manion I (2009) Child and youth mental health: integrated health care using contemporary competency-based teams. Paediatr Child Health 14(5):315PubMedPubMedCentralGoogle Scholar
  40. 40.
    Baumbusch JL, Kirkham SR, Khan KB, McDonald H, Semeniuk P, Tan E, Anderson JM (2008) Pursuing common agendas: a collaborative model for knowledge translation between research and practice in clinical settings. Res Nurs Health 31(2):130–140CrossRefPubMedGoogle Scholar
  41. 41.
    Lomas J (1991) Words without action? The production, dissemination, and impact of consensus recommendations. Annu Rev Public Health 12(1):41–65CrossRefPubMedGoogle Scholar
  42. 42.
    McGrath PJ, Lingley-Pottie P, Emberly DJ, Thurston C, McLean C (2009) Integrated knowledge translation in mental health: family help as an example. J Can Acad Child Adolesc Psychiatry 18(1):30PubMedPubMedCentralGoogle Scholar
  43. 43.
    CIHR Knowledge Translation & Commercialization E-Newsletter/E-Bulletin de l’application des connaissances et commercialisation des IRSC.

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Ashok Malla
    • 1
    • 2
    • 7
  • Srividya Iyer
    • 1
    • 2
  • Patrick McGorry
    • 3
  • Mary Cannon
    • 4
  • Helen Coughlan
    • 4
  • Swaran Singh
    • 5
  • Peter Jones
    • 6
  • Ridha Joober
    • 1
    • 2
  1. 1.Department of PsychiatryMcGill UniversityMontrealCanada
  2. 2.ACCESS Open Minds CanadaDouglas Mental Health University InstituteMontrealCanada
  3. 3.ORYGENUniversity of MelbourneParkvilleAustralia
  4. 4.Department of PsychiatryRoyal College of Surgeons of IrelandDublinIreland
  5. 5.Division of Mental HealthWarwick UniversityCoventryEngland, UK
  6. 6.Department of PsychiatryCambridge UniversityCambridgeEngland, UK
  7. 7.Douglas Hospital Research Centre, ACCESS Open Minds PavilionMontrealCanada

Personalised recommendations