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Cited by 208Mental Health Research TopicsBipolar Disorder and TreatmentPsychiatric care and mental health services

Right care, first time: a highly personalised and measurement‐based care model to manage youth mental health

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Hickie, Ian B, Scott, Elizabeth M, Cross, Shane P, Iorfino, Frank, Davenport, Tracey A, Guastella, Adam J, Naismith, Sharon L, Carpenter, Joanne S +8 more·2019·Medical Journal of Australia
DOI 10.5694/mja2.50383
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Abstract

Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change. Consequently, the effects of adolescent-onset mood and psychotic syndromes can have long term consequences. A key clinical challenge for youth mental health is to develop and test new systems that align with current evidence for comorbid presentations and underlying neurobiology, and are useful for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. Our highly personalised and measurement-based care model includes three core concepts: ▶ A multidimensional assessment and outcomes framework that includes: social and occupational function; self-harm, suicidal thoughts and behaviour; alcohol or other substance misuse; physical health; and illness trajectory. ▶ Clinical stage. ▶ Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on proposed pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). The model explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within this highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care as well as utilisation of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality, mental health care for young people. CHAPTER 1: MULTIDIMENSIONAL OUTCOMES IN YOUTH MENTAL HEALTH CARE: WHAT MATTERS AND WHY?: Mood and psychotic syndromes present one of the most serious public health challenges that we face in the 21st century. Factors including prevalence, age of onset, and chronicity contribute to substantial burden and secondary risks such as alcohol or other substance misuse. Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change; thus, effects can have long term consequences. We propose five key domains which make up a multidimensional outcomes framework that aims to address the specific needs of young people presenting to health services with emerging mental illness. These include social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness type, stage and trajectory. Impairment and concurrent morbidity are well established in young people by the time they present for mental health care. Despite this, services and health professionals tend to focus on only one aspect of the presentation - illness type, stage and trajectory - and are often at odds with the preferences of young people and their families. There is a need to address the disconnect between mental health, physical health and social services and interventions, to ensure that youth mental health care focuses on the outcomes that matter to young people. CHAPTER 2: COMBINING CLINICAL STAGE AND PATHOPHYSIOLOGICAL MECHANISMS TO UNDERSTAND ILLNESS TRAJECTORIES IN YOUNG PEOPLE WITH EMERGING MOOD AND PSYCHOTIC SYNDROMES: Traditional diagnostic classification systems for mental disorders map poorly onto the early stages of illness experienced by young people, and purport categorical distinctions that are not readily supported by research into genetic, environmental and neurobiological risk factors. Consequently, a key clinical challenge in youth mental health is to develop and test new classification systems that align with current evidence on comorbid presentations, are consistent with current understanding of underlying neurobiology, and provide utility for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. This chapter outlines a transdiagnostic framework for classifying common adolescent-onset mood and psychotic syndromes, combining two independent but complementary dimensions: clinical staging, and three proposed pathophysiological mechanisms. Clinical staging reflects the progression of mental disorders and is in line with the concept used in general medicine, where more advanced stages are associated with a poorer prognosis and a need for more intensive interventions with a higher risk-to-benefit ratio. The three proposed pathophysiological mechanisms are neurodevelopmental abnormalities, hyperarousal and circadian dysfunction, which, over time, have illness trajectories (or pathways) to psychosis, anxious depression and bipolar spectrum disorders, respectively. The transdiagnostic framework has been evaluated in young people presenting to youth mental health clinics of the University of Sydney's Brain and Mind Centre, alongside a range of clinical and objective measures. Our research to da

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  • MBC has been associated with multi-faceted clinical benefits, including greater retention, engagement, and therapeutic alliances during treatment with better patient outcomes that occur more quickly and last longer than traditional care.

    “MBC has been associated with multi-faceted clinical benefits, including greater retention, engagement, and therapeutic alliances during treatment with better patient outcomes that occur more quickly and last longer than traditional care (14-19).”

    From Initial insights from a quality improvement initiative to develop an evidence-informed young adult substance use program (2022) · cites this paper as [19]

    Section 4, “Continuous and ongoing outcome monitoring” (page not provided), says routine outcome monitoring has been shown to reduce deterioration and improve treatment outcomes. The paper does not establish that measurement-based care improves retention, engagement, or therapeutic alliances, or that outcomes occur more quickly and last longer than with traditional care. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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  12. Hamilton MP, Hetrick SE, Mihalopoulos C, et al. Identifying attributes of care that may improve cost-effectiveness in the youth 8 Direct and indirect interventions that target social and occupational functioning CBT = cognitive behaviour therapy; DBT = dialectical behaviour therapy; IPT = interpersonal therapy; MCT = meta-cognitive therapy. Icons from www.flati con.com: alarm bell, bicycle and magnifying glass/brain made by Freepik; wine bottle/glass made by srip; team education made by Eucalyp. A wide range of assessments targeting each multidimensional outcome domain and illness type are outlined in Box 3 and Box 4. Here, we emphasise the importance of social and occupational function (SaOF) as a key long term outcome in youth mental health. This is a schematic representation of interventions that target SaOF directly (direct interventions) compared with those that target the other outcome domains that have bidirectional relationships with SaOF. Consequently, these interventions may have indirect effects on SaOF. ◆ 13265377, 2019, S9, Right care, first time MJA2 211 (9 Suppl) ▪ 4 November 2019 S39 mental health service system. Med J Aust 2017; 207 (10 Suppl): S27-S37. https ://www.mja. com.au/journ al/2017/207/10/ident ifying-attri butes-care-may-impro ve-cost-effec tiven ess-youth-mental-health 18 · DOI
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Authors
Hickie, I. B., Scott, E. M., Cross, S. P., Iorfino, F., Davenport, T. A., Guastella, A. J., Naismith, S. L., Carpenter, J. S., Rohleder, C., Crouse, J. J., Hermens, D. F., Koethe, D., Markus Leweke, F., Tickell, A. M., Sawrikar, V., & Scott, J.
Affiliations
  • The University of Sydney (AU)
  • Brain and Mind CentreUniversity of Sydney Sydney NSW
Corresponding author
  • Hickie, Ian B
  • Cross, Shane P
  • Iorfino, Frank
  • Carpenter, Joanne S
  • Rohleder, Cathrin
  • Crouse, Jacob J
ORCID
Venue
Medical Journal of Australia
Publisher
Wiley
Published
2019-11
Volume
211
Issue
S9
Pages
S3-S46
ISSN
  • 0025-729X (ISSN-L)
  • 1326-5377
DOI
10.5694/mja2.50383
OpenAlex
W2984705150
Cited by
208
References
424
Citations by year
2026: 22 · 2025: 39 · 2024: 43 · 2023: 29 · 2022: 29 · 2021: 31 · 2020: 14 · 2019: 1
FWCI
22.02
Type
journal article
Language
en
Open access
Licence
doi.wiley.com/10.1002/tdm_license_1.1 (tdm)
Locations
  • The Medical Journal of Australia (publishedVersion)
  • PubMed (publishedVersion)
Funders
Department of Health, Australian Government
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords
youth mental health, measurement-based care, individualized care, adolescent-onset psychosis, mood disorders, bipolar spectrum, anxious depression, self-harm, suicidal ideation, substance abuse, physical health, illness trajectory, clinical stage, hyperarousal, circadian rhythm, neurodevelopmental mechanisms
MeSH terms
Adolescent, Anxiety Disorders, Australia, Mental Disorders, Bipolar Disorder, Child Welfare, Health Planning Guidelines, Humans, Male, Mental Health, Patient Care Planning, Professional-Patient Relations, Psychotic Disorders, Disease Management, Young Adult

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