The document discusses youth mental health and university students. It provides an overview of Patrick McGorry's presentation on maximizing mental wealth for university students. McGorry discusses the problems of young people not accessing quality mental health services when needed and the solutions of building evidence-based youth services and conducting integrated research. He also outlines the high costs of mental illness and importance of early intervention during a developmental period of high risk.

1. Youth Mental Health
and University Students
Maximising Mental Wealth
DOSSANZ Conference 11-13 June 2019
Patrick McGorry
Professor of Youth Mental Health
University of Melbourne

2. Beddington et al 2008 Nature
DEVELOPMENTAL PERSPECTIVE:
THE MENTAL WEALTH OF NATIONS

4. The problem we are trying to solve
• Young people with mental ill-health are not able to access the quality,
evidence-based services they need, when they need them
• This drives poor outcomes including reliance on welfare, early mortality
due to severe physical health issues, and death by suicide
Solution
• Build and deliver a comprehensive, evidence-based youth mental health
service centred around young people’s needs that is scalable nationally
and internationally
• Conduct integrated and top quality research guided by young people and Spread
this new knowledge throughout the mew YMH system and beyond
• Create and nurture the fields of youth mental health and early intervention

5. GBD: All NCDs

6. GBD: Cancer

7. GBD: Mental Illness

8. Figure 8
The Lancet 2016 387, 2423-2478DOI: (10.1016/S0140-6736(16)00579-1)
Copyright © 2016 Elsevier

9. Mental Wealth
Why economists are our
new best friends

10. Costs
─ Mental illness as a source of morbidity has
a cost. Direct and indirect costs of mental
ill-health are estimated to amount over
4% of GDP, more than
that of cancer, diabetes and chronic
respiratory disease combined
─ Mental illness costs are expected
to more than double by 2030.
Low- and middle-
income countries
High-income countries World
Direct
costs
Indirect
costs
Total cost
of illness
Direct
costs
Indirect
costs
Total cost
of illness
Direct
costs
Indirect
costs
2010 287 583 870 536 1088 1624 823 1671 2493
2030 697 1416 2113 1298 2635 3933 1995 4051 6046
Global cost of metal health conditions in 2010 and 2030. Costs shown in billions of 2010 $USD
Mental health and
cardiovascular diseases
are the top drivers of lost
output internationally
Breakdown of NCD cost
by disease type, based
on EPIC model5

11. Not working costs

13. ‘If individuals are forced to choose between
saving the life of a 2-year-old and saving it for a
22-year-old, most prefer to save the 22-year-
old. A range of studies confirms this broad
social preference to “weight” the value of a
year lived by a young adult more heavily than
one lived by a very young child or an older
adult.’
Murray and Lopez 1996 (GBD)

14. “The transition to adulthood is poorly understood in
spite of the fact that it is probably the age period
when most adult disorders have their peak rates of
incidence”
Mrazek & Haggerty, 1994
Institute of Medicine

15. Physical illnesses
Mental illnesses
Annualincidenceper1,000people Global Burden of Disease:
#1 Health Issue for Young People

16. #1 health issue for young people
Age
Burden of disease by age

18. JAACAP 2011

19. Real maturation
Actual development in the context of mental ill-health in young people
Vital to acknowledge the impact of illness on developmental
trajectories

21. Orygen: National Centre of Excellence in Youth Mental Health

23. THE NEGLECT OF THE MENTAL
HEALTH OF YOUNG PEOPLE
─ “It has always been a puzzle to me that the period of life of maximum
disturbance, adolescence, is the one of least interest to both psychiatrists and
governments….
─ …...the neglect of adolescent psychiatry is a special form of self-harm undertaken
by adult society.”
─ John Gunn 2004

24. “Existing systems and structures focus almost
exclusively on children or on adults, meaning
few investments and interventions are
directed specifically to young people.”
Melinda Gates

25. Young people don’t seek or get
professional help!!
Only 13% of young men and
31% of young women access
professional mental health
care
Young men aged 16-24 have
the lowest professional help-
seeking of any age group

30. supports
ongoing care
minimalaccess
complex care
minimalaccess
or noservice
basic care
access via
headspace
employment
and education
sexual
health
alcoholand
other drugs
family
support
physical
health
x
Little
continuity of
care
x
limited case
management
x
little home
treatment or
outreachcapacity
x
familysupport
notproperly
funded
x
funding streams
for vocational and
drug programsnot
supported
x
limited sessions
regardless ofwhat
the clientneeds
x
no shared
medicalrecords
x
limitedpeer
support
x
No
integration
of mental
health
treatment
Any supports
available are
usually located
at different
services with
no continuity
of care
The current failingsystem
mental
health
treatment
emergency care
access usually via
ambulance or police

31. Twenge, J. M., Cooper, A. B., Joiner, T. E., Duffy, M. E., & Binau, S. G. (2019, March 14). Age,
Period, and Cohort Trends in Mood Disorder Indicators and Suicide-Related Outcomes in a
Nationally Representative Dataset, 2005–2017. Journal of Abnormal Psychology. Advance
online publication. http://dx.doi.org/10.1037/abn0000410

32. A New Architecture and Culture
of Care
Integrated Youth Mental Health
through Enhanced Primary Care
A Global Paradigm

33. One stop service for mental health,
AOD, physical health, vocational
assistance that is youth friendly and
free or low cost

40. YOUTH MENTAL HEALTH REFORM WORLDWIDE
40

41. YOUTH MENTAL HEALTH REFORM WORLDWIDE
41
Western
Australia
Northern
Territory
Queensland
South
Australia
New South
Wales
Victoria
Tasmania
AUSTRALIA
headspace centres opening in 2017 - 2019
centres established

42. YOUTH MENTAL HEALTH REFORM WORLDWIDE
42

44. YOUTH MENTAL HEALTH REFORM WORLDWIDE
44

45. Headstrong & Jigsaw Services

47. YOUTH MENTAL HEALTH REFORM WORLDWIDE
47

50. HEADSPACE DENMARK

51. YOUTH MENTAL HEALTH REFORM WORLDWIDE
51

52. YOUTH MENTAL HEALTH REFORM WORLDWIDE
52

53. YOUTH MENTAL HEALTH REFORM WORLDWIDE
53

54. YOUTH MENTAL HEALTH REFORM WORLDWIDE
54

55. Vision for Youth Mental Health
“In 2020 young people in all
communities will have access to the
knowledge, skills and services
necessary to respond to, and support
them in periods of mental ill-health”

58. Why universities play an
important role
In 2016 over 650,000
domestic students were
under 25 years of age (Data
Snapshot Universities
Australia, 2018) and ‘000s
more international students
More than one third of young
Australians have/are seeking
a bachelor’s degree or higher
(DET, 2015).
Bloom, D.E., et al., The global economic burden of non-
communicable disease. . 2011, World Economic Forum:
Geneva.

59. Under the radar report
Policy report
Released May 2017
─ What is known about
mental health of Australian
university students?
─ What’s the impact of
mental ill-health on
universities?
─ How are Australian
university and mental
health policies and
services responding?
─ What needs to be done?

60. The mental health of Australian
University students
Research
Paucity of Australian-based
research
What is available limited by
sample, lack of standardised
screening and self report
Overall suggests higher
levels psychological distress
among Uni students
National data
2016 national survey
tertiary students (NUS &
headspace, 2017)
n=3,303
- 65 per cent reported
high or very high
psychological distress
- 35.4 per cent had
thoughts of self-harm
or suicide
Counselling
services
2013 ANZSSA Managers
Survey (Andrews, 2016)
n=31
- 64% unable to respond
to all requests within
2wks
- 100% agreed severity
and complexity had
increased.

61. Risk factors
Higher risk groups Risk factors
International
students (Forbes-
Mewett,2011)
Rural/Regional
University students
(Mulder, 2015)
Law/Medicine
(Leahy, 2010)
Low socio-
economic
backgrounds
(Eisenberg et al,
2007)
Academic stress (Kruisselbrink Flatt, 2013;
Deasy et al., 2014)
Financial stress (Eisenberg et al 2013; Stallman
2010; Cvetskovski, 2012)
Drug and alcohol use (Hallett et al., 2012,
Hussain et al., 2013)
Lack of sleep (Thomee et al., 2012, Hershner
and Chervin, 2014)
Poor diet (Kruisselbrink Flatt, 2013)
Relocation (King, 2011) and transitional stress
between levels of education (Cleary et al.,
2011)

62. Impact
 41% students considering early
course departure cite health
and stress reasons (QILT, 2017)
 Economic impact – lost of
future workforce potential,
downstream mental health
system
• Increasing demand for mental
health services (including
counselling and disability)
• EI in college student mental
health social return $6.49:$1
spent (Ashwood, 2015)
Student Experience Survey 2013:
Reasons for considering early course
departure (Edwards, 2015)
Low-SES, non-
metro and
Aboriginal and
Torres Strait
Islander
students
High-SES, metro
and non-
Indigenous
students
Health or stress Boredom/lack
of interest
Financial
difficulties
Change of
direction
Family
responsibilities
Career
prospects

63. Call for action
 ‘Tone from the top’ (Veness, 2016)
 Requires both university and mental
health sector leaders to commit.
 Australia needs nationally
recognised guidance to support
universities deliver best practice
responses.
 Recent funding announcement by
the Australian Government for the
development of a National
University Mental Health
Framework.

64. Australian University Mental
Health Framework

65. Overview
The Australian University Mental Health Framework project:
─ Purpose
─ Vision and values
─ Key principles
─ Timeline and project activities
Our other work in this area
─ Universitas 21, Student Mental Health Project
─ International Student Welfare Project

66. Purpose
The Australian University Mental Health Framework (the
Framework) will provide all Australian universities with
guidelines and standards through which they can create
learning environments that are conducive to:
─ Good mental health and wellbeing
─ Preventing mental health issues
─ Strengthening the integration between universities and
community mental health services

67. Vision and values
Vision
An Australian University Mental Health Framework that provides clear, practical
guidelines to support universities to create positive learning environments,
prevent mental health issues and improve education outcomes.
Values
─ Young people with mental ill-health should have the opportunity to access
mental health services
─ Mental health is not solely the responsibility of any one organization or
sector
─ Universities operate within different contexts and environments, and
students come from diverse backgrounds and communities
─ Partnerships across sectors and with young people (inc. those with lived
experience of mental ill-health) are critical
─ Requires long term commitment

68. Principles
The Framework should:
─ support a whole-of-university approach
─ incorporate evidence-informed recommendations and guidelines
─ be pragmatic and realistic, flexible and adaptable
─ be student centred
─ share responsibility within and across sectors, leading to a
collective impact
─ build on existing work, move forward, and provide a foundation for
further research and evaluation
─ build capacity

69. Timeline and activities
Timeline
2 year project, July 2018 – June 2020
Activity delivery
─ Research and scoping
─ Key stakeholder consultation (mental health, universities and
students)
─ Framework development and design
─ Stakeholder acceptance
─ Framework launch

70. Framework key focus areas
─ Healthy Universities
─ Student mental health supports and services
─ Data to reflect, learn, adapt
─ Collaboration for continuous innovation and reform

71. Universitas 21 (U21) Health
Sciences Group (HSG) – Student
Mental Health Project

72. U21 HSG Student Mental Health Project
─ An initiative to progress the ‘Declaration on Student Mental
Health’ which could provide a platform for:
o international cooperation,
o information data collection and
o Sharing and reporting on activities and actions.
─ Focus on broader adoption outside of health sciences to a
‘whole of university approach’

73. U21 HSG Mental Health Working Group
─ Met monthly since January 2019
─ Current representation:
o University of Melbourne
o University of Birmingham
o University College Dublin
o University of Glasgow
o Hong Kong University
o University of New South Wales
o University of Queensland
o University of Johannesburg

74. International student welfare
project

75. Project overview
Aim to identify the mental health and wellbeing needs and help-
seeking preferences of international students through the
facilitation of focus groups.
These findings will inform the development of a web-based
platform where international students can access mental health
and wellbeing support.

76. Project specifics
Round 1: Needs assessment & help-seeking preferences
• 4 focus groups (2 x new international students / 2 x established
international students)
• To identify the challenges and unmet needs experienced by
international students.
Round 2: Content development & review
• 4 focus groups
• Investigate user testing ideas for content and system features for
planned web based wellbeing platform.

77. Reflection
“Of all university students who have a significant
mental health issue, 86% will drop out of their
degree. As far as I was concerned, that is a large
portion of incredible nurses, lawyers, scientists,
artists, musicians, teachers that we may have lost,
and I didn’t want that to happen when I could
really be doing something about it.”
Sarah, Member of batyr Being Herd Program and President of batyr
University Program at UTS

78. Duffy et al Lancet Psychiatry
July 16 2019