Skip to main content Accessibility help
Hostname: page-component-5c569c448b-8lphq Total loading time: 0.726 Render date: 2022-07-06T08:40:27.091Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "useNewApi": true } hasContentIssue true

Chapter 13 - Transforming Cultures to Enable Stage-Related Care of Mental Ill-Health

A Youth Mental Health Challenge

from Section 4 - Novel Treatment Strategies

Published online by Cambridge University Press:  08 August 2019

Patrick D. McGorry
University of Melbourne
Ian B. Hickie
University of Sydney
Get access


Although mental health issues are the key health concern for young people, contributing 45% of the total burden of disease for those aged 10-24 years, young people have the poorest access to mental health care. Current service approaches are insufficient, poorly designed and not well supported. Transformational reform of mental health care is needed, based on principles of evidence-informed care, early intervention, and a focus on the developmental period of greatest need and capacity to benefit from investment: emerging adulthood. The most appropriate care models for this period place emphasis on offering care that is appropriate to early stages of illness, pre-emptive in nature, and with a strong preventive focus. This sits best with a clinical staging approach, which distinguishes earlier and milder clinical phenomena from those that accompany illness progression and chronicity. This provides a clinically useful framework that is sensitive to risk/benefit considerations and facilitates the selection of earlier, safer interventions, and favours a preventive or pre-emptive treatment approach. In this chapter, rapidly emerging examples of modern, stigma-free cultures of care designed and operated with young people themselves are described. This includes headspace and technologically enhanced service delivery models. Future directions for youth services are also described.

Clinical Staging in Psychiatry
Making Diagnosis Work for Research and Treatment
, pp. 261 - 277
Publisher: Cambridge University Press
Print publication year: 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Ambresin, A.-E., Bennett, K., Patton, G. C., Sanci, L. A., & Sawyer, S. M. (2013). Assessment of youth-friendly health care: a systematic review of indicators drawn from young people’s perspectives. Journal of Adolescent Health, 52(6), 670681.CrossRefGoogle ScholarPubMed
Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., … Cassiello-Robbins, C. (2017). The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: a randomized clinical trial. JAMA Psychiatry, 74(9), 875884.CrossRefGoogle ScholarPubMed
Birchwood, M., & Singh, S. P. (2013). Mental health services for young people: matching the service to the need. British Journal of Psychiatry, 202(54), S1S2.CrossRefGoogle Scholar
Boswell, J. F., Kraus, D. R., Miller, S. D., & Lambert, M. J. (2015). Implementing routine outcome monitoring in clinical practice: benefits, challenges, and solutions. Psychotherapy Research, 25(1), 619.CrossRefGoogle ScholarPubMed
Burns, J., & Birrell, E. (2014). Enhancing early engagement with mental health services by young people. Psychology Research and Behavior Management, 7, 303312.CrossRefGoogle ScholarPubMed
Burns, J., Birrell, E., Bismark, M., Pirkis, J., Davenport, T., Hickie, I., … Ellis, L. (2015). The role of technology in Australian youth mental health reform. Australian Health Review, 40(5), 584590.CrossRefGoogle Scholar
Chandra, A., & Minkovitz, C. S. (2006). Stigma starts early: gender differences in teen willingness to use mental health services. Journal of Adolescent Health, 38(6), e1e8.CrossRefGoogle ScholarPubMed
Copeland, W., Shanahan, L., Costello, E. J., & Angold, A. (2011). Cumulative prevalence of psychiatric disorders by young adulthood: a prospective cohort analysis from the Great Smoky Mountains Study. Journal of the American Academy of Child and Adolescent Psychiatry, 50(3), 252261.CrossRefGoogle ScholarPubMed
Cross, S. P. M., Hermens, D. F., & Hickie, I. B. (2016a). Treatment patterns and short-term outcomes in an early intervention youth mental health service. Early Intervention in Psychiatry, 10(1), 8897.CrossRefGoogle Scholar
Cross, S. P. M., Hermens, D. F., Scott, E. M., Ottavio, A., McGorry, P. D., & Hickie, I. B. (2014). A clinical staging model for early intervention youth mental health services. Psychiatric Services, 65(7), 939943.CrossRefGoogle ScholarPubMed
Cross, S. P. M., Hermens, D. F., Scott, J., Salvador-Carulla, L., & Hickie, I. B. (2016b). Differential impact of current diagnosis and clinical stage on attendance at a youth mental health service. Early Intervention in Psychiatry, 11(3), 255262.CrossRefGoogle Scholar
Ebert, D. D., Zarski, A.-C., Christensen, H., Stikkelbroek, Y., Cuijpers, P., Berking, M., & Riper, H. (2015). Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: a meta-analysis of randomized controlled outcome trials. PLoS One, 10(3), e0119895.CrossRefGoogle ScholarPubMed
Ellis, L. A., Collin, P., Hurley, P. J., Davenport, T. A., Burns, J. M., & Hickie, I. B. (2013). Young men’s attitudes and behaviour in relation to mental health and technology: implications for the development of online mental health services. BMC Psychiatry, 13(1), 119.CrossRefGoogle ScholarPubMed
Fusar-Poli, P., Yung, A. R., McGorry, P., & van Os, J. (2014). Lessons learned from the psychosis high-risk state: towards a general staging model of prodromal intervention. Psychological Medicine, 44(1), 1724.CrossRefGoogle ScholarPubMed
Gibb, S. J., Fergusson, D. M., & Horwood, L. J. (2010). Burden of psychiatric disorder in young adulthood and life outcomes at age 30. British Journal of Psychiatry, 197(2), 122127.CrossRefGoogle ScholarPubMed
Gore, F. M., Bloem, P. J. N., Patton, G. C., Ferguson, J., Joseph, V., Coffey, C., … Mathers, C. D. (2011). Global burden of disease in young people aged 10–24 years: a systematic analysis. Lancet, 377(9783), 20932102.CrossRefGoogle ScholarPubMed
Gunn, J. (2004). Foreword. In Bailey, S. & Dolan, M. (Eds), Adolescent forensic psychiatry. London: Arnold.Google Scholar
Hatfield, D., McCullough, L., Frantz, S. H., & Krieger, K. (2010). Do we know when our clients get worse? An investigation of therapists’ ability to detect negative client change. Clinical Psychology and Psychotherapy, 17(1), 2532.Google ScholarPubMed
Hickie, I. B., Scott, E. M., Hermens, D. F., Naismith, S. L., Guastella, A. J., Kaur, M., … McGorry, P. D. (2013a). Applying clinical staging to young people who present for mental health care. Early Intervention in Psychiatry, 7(1), 3143.CrossRefGoogle ScholarPubMed
Hickie, I. B., Scott, J., Hermens, D. F., Scott, E. M., Naismith, S. L., Guastella, A. J., … McGorry, P. D. (2013b). Clinical classification in mental health at the cross-roads: which direction next? BMC Medicine, 11, 125.CrossRefGoogle ScholarPubMed
Hilferty, F., Cassells, R., Muir, K., Duncan, A., Christensen, D., Mitrou, F., … Katz, I. (2015). Is headspace making a difference to young people’s lives? Final report of the independent evaluation of the headspace program. Sydney: Social Policy Research Centre, UNSW Australia.
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. Australasian Psychiatry, 22(3), 228234.CrossRefGoogle ScholarPubMed
Illback, R. J., & Bates, T. (2011). Transforming youth mental health services and supports in Ireland. Early Intervention in Psychiatry, 5(1), S22S27.CrossRefGoogle Scholar
Iorfino, F., Hickie, I. B., Lee, R. S. C., Lagopoulos, J., & Hermens, D. F. (2016). The underlying neurobiology of key functional domains in young people with mood and anxiety disorders: a systematic review. BMC Psychiatry, 16(1), 156.CrossRefGoogle ScholarPubMed
Kazdin, A. E. (2014). Evidence-based psychotherapies II: changes in models of treatment and treatment delivery. South African Journal of Psychology, 45(1), 321.CrossRefGoogle Scholar
Kohn, R., Saxena, S., Levav, I., & Saraceno, B. (2004). The treatment gap in mental health care. Bulletin of the World Health Organization, 82(11), 858866.Google ScholarPubMed
McGorry, P. D. (2007). The specialist youth mental health model: strengthening the weakest link in the public mental health system. Medical Journal of Australia, 187(7), S53.Google ScholarPubMed
McGorry, P. D., Bates, T., & Birchwood, M. (2013). Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK. British Journal of Psychiatry, 202(54), S30S35.CrossRefGoogle Scholar
McGorry, P. D., Goldstone, S. D., Parker, A. G., Rickwood, D. J., & Hickie, I. B. (2014). Cultures for mental health care of young people: an Australian blueprint for reform. Lancet Psychiatry, 1(7), 559568.CrossRefGoogle ScholarPubMed
McGorry, P. D., Hickie, I. B., Yung, A. R., Pantelis, C., & Jackson, H. J. (2006). Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Australian and New Zealand Journal of Psychiatry, 40(8), 616622.CrossRefGoogle ScholarPubMed
McGorry, P. D., Nelson, B., Goldstone, S., & Yung, A. R. (2010). Clinical staging: a heuristic and practical strategy for new research and better health and social outcomes for psychotic and related mood disorders. Canadian Journal of Psychiatry, 55(8), 486497.CrossRefGoogle ScholarPubMed
McGorry, P. D., Purcell, R., Goldstone, S., & Amminger, G. P. (2011). Age of onset and timing of treatment for mental and substance use disorders: implications for preventive intervention strategies and models of care. Current Opinion in Psychiatry, 24(4), 301306.CrossRefGoogle ScholarPubMed
McGorry, P. D., Purcell, R., Hickie, I. B., & Jorm, A. F. (2007a). Investing in youth mental health is a best buy. Medical Journal of Australia, 187(7), S5S7.Google Scholar
McGorry, P. D., Purcell, R., Hickie, I. B., Yung, A. R., Pantelis, C., & Jackson, H. J. (2007b). Clinical staging: a heuristic model for psychiatry and youth mental health. Medical Journal of Australia, 187(7), S40S42.Google ScholarPubMed
McGorry, P. D., Tanti, C., Stokes, R., Hickie, I. B., Carnell, K., Littlefield, L. K., & Moran, J. (2007c). headspace: Australia’s National Youth Mental Health Foundation – where young minds come first. Medical Journal of Australia, 187(7), S68S70.Google ScholarPubMed
McLaren, S., Belling, R., Paul, M., Ford, T., Kramer, T., Weaver, T., … Singh, S. P. (2013). ‘Talking a different language’: an exploration of the influence of organizational cultures and working practices on transition from child to adult mental health services. BMC Health Services Research, 13, 254.CrossRefGoogle ScholarPubMed
Nordentoft, M., Rasmussen, J. Ø., Melau, M., Hjorthøj, C. R., & Thorup, A. A. E. (2014). How successful are first episode programs? A review of the evidence for specialized assertive early intervention. Current Opinion in Psychiatry, 27(3), 167172.CrossRefGoogle ScholarPubMed
Patel, V., Flisher, A. J., Hetrick, S., & McGorry, P. (2007). Mental health of young people: a global public-health challenge. Lancet, 369(9569), 13021313.CrossRefGoogle ScholarPubMed
Patton, G. C., Coffey, C., Romaniuk, H., Mackinnon, A., Carlin, J. B., Degenhardt, L., … Moran, P. (2014). The prognosis of common mental disorders in adolescents: a 14-year prospective cohort study. Lancet, 383(9926), 14041411.CrossRefGoogle ScholarPubMed
Paul, M., Ford, T., Kramer, T., Islam, Z., Harley, K., & Singh, S. P. (2013). Transfers and transitions between child and adult mental health services. British Journal of Psychiatry, 202(54), S36S40.CrossRefGoogle Scholar
Paul, M., Street, C., Wheeler, N., & Singh, S. P. (2015). Transition to adult services for young people with mental health needs: a systematic review. Clinical Child Psychology and Psychiatry, 20(3), 436457.CrossRefGoogle ScholarPubMed
Purcell, R., Goldstone, S., Moran, J., Albiston, D., Edwards, J., Pennell, K., & McGorry, P. (2011). Toward a twenty-first century approach to youth mental health care: some Australian initiatives. International Journal of Mental Health, 40(2), 7287.CrossRefGoogle Scholar
Rao, S., Pariyasami, S., Tay, S. A., Lim, L. K., Yuen, S., Poon, L. Y., … Verma, S. (2013). Support for Wellness Achievement Programme (SWAP): a service for individuals with at-risk mental state in Singapore. Annals of the Academy of Medicine, Singapore, 42(10), 552555.Google Scholar
Richards, D. A., Bower, P., Pagel, C., Weaver, A., Utley, M., Cape, J., … Vasilakis, C. (2012). Delivering stepped care: an analysis of implementation in routine practice. Implementation Science, 7, 3.CrossRefGoogle ScholarPubMed
Rickwood, D. J., Deane, F. P., & Wilson, C. J. (2007). When and how do young people seek professional help for mental health problems? Medical Journal of Australia, 187(7), S35S39.Google Scholar
Rickwood, D. J., Mazzer, K. R., Telford, N. R., Parker, A. G., Tanti, C. J., & McGorry, P. D. (2015a). Changes in psychological distress and psychosocial functioning in young people visiting headspace centres for mental health problems. Medical Journal of Australia, 202(10), 537542.CrossRefGoogle ScholarPubMed
Rickwood, D. J., Telford, N. R., Mazzer, K. R., Parker, A. G., Tanti, C. J., & McGorry, P. D. (2015b). The services provided to young people through the headspace centres across Australia. Medical Journal of Australia, 202(10), 533536.CrossRefGoogle ScholarPubMed
Shimokawa, K., Lambert, M. J., & Smart, D. W. (2010). Enhancing treatment outcome of patients at risk of treatment failure: meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of Consulting and Clinical Psychology, 78(3), 298311.CrossRefGoogle ScholarPubMed
Singh, S. P., Paul, M., Ford, T., Kramer, T., Weaver, T., McLaren, S., … White, S. (2010). Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study. British Journal of Psychiatry, 197(4), 305312.CrossRefGoogle ScholarPubMed
Verma, S., Poon, L.-Y., Lee, H., Rao, S., & Chong, S.-A. (2012). Evolution of early psychosis intervention services in Singapore. East Asian Archives of Psychiatry, 22(3), 114117.Google ScholarPubMed
Walfish, S., McAlister, B., O’Donnel, P., & Lambert, M. J. (2012). An investigation of self-assessment bias in mental health providers. Psychological Reports, 110(2), 639644.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats