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

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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, Rohleder, Cathrin, Crouse, Jacob J, Hermens, Daniel F, Koethe, Dagmar, Markus Leweke, F, Tickell, Ashleigh M, Sawrikar, Vilas, Scott, Jan·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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Prognostic Subgroups for Citalopram Response in the STAR*D Trial
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Project Synergy: co‐designing technology‐enabled solutions for Australian mental health services reform
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Correlating anterior insula gray matter volume changes in young people with clinical and neurocognitive outcomes: an MRI study
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Diurnal alterations in circadian genes and peptides in major depressive disorder before and after escitalopram treatment
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Melatonin and Melatonin Agonists as Adjunctive Treatments in Bipolar Disorders
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A Meta-Analysis of Transdiagnostic Cognitive Behavioural Therapy in the Treatment of Child and Young Person Anxiety Disorders
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Metacognitive therapy versus disorder-specific CBT for comorbid anxiety disorders: A randomized controlled trial
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Treatment patterns and short‐term outcomes in an early intervention youth mental health service
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Neuropsychological evidence for abnormal neurodevelopment associated with early-onset psychoses
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Contributing lives, thriving communities: report of the national review of mental health programmes and services
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Validation of the InnoWell Platform: Protocol for a Clinical Trial
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ADOLESCENT SUICIDE ATTEMPTS AND ADULT ADJUSTMENT
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Clinical relevance of findings in trials of CBT for depression
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Using New and Emerging Technologies to Identify and Respond to Suicidality Among Help-Seeking Young People: A Cross-Sectional Study
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Distinguishing young people with emerging bipolar disorders from those with unipolar depression
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A systematic review on the role of anticonvulsants in the treatment of acute bipolar depression
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What matters to patients? A systematic review of preferences for medication-associated outcomes in mental disorders
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Improving functional outcome in bipolar disorder: A pilot study on metacognitive training
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A Randomized Controlled Trial of Executive Functioning Training Compared With Perceptual Training for Schizophrenia Spectrum Disorders: Effects on Neurophysiology, Neurocognition, and Functioning
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The meaning of childhood attention-deficit hyperactivity symptoms in patients with a first-episode of schizophrenia-spectrum psychosis
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Frequent alcohol, nicotine or cannabis use is common in young persons presenting for mental healthcare: a cross-sectional study
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Social Recovery Therapy in improving activity and social outcomes in early psychosis: Current evidence and longer term outcomes
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Evidence-based psychotherapies II: changes in models of treatment and treatment delivery
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Evaluating differential developmental trajectories to adolescent-onset mood and psychotic disorders
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Metacognitive training for young subjects ( MCT young version) in the early stages of psychosis: Is the duration of untreated psychosis a limiting factor?
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Frontal lobe changes occur early in the course of affective disorders in young people
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Parallel Changes in Mood and Melatonin Rhythm Following an Adjunctive Multimodal Chronobiological Intervention With Agomelatine in People With Depression: A Proof of Concept Open Label Study
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Emotional Stroop performance predicts disorganization in schizophrenia
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Microstructural white matter changes are correlated with the stage of psychiatric illness
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Where should bipolar disorder appear in the meta-structure?: Paper 7 of 7 of the thematic section: ‘A proposal for a meta-structure for DSM-V and ICD-11’
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Review: Restoring circadian rhythms: a new way to successfully manage depression
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Predicting early transition from sub-syndromal presentations to major mental disorders
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Association between diabetes and mood disorders and the potential use of anti-hyperglycemic agents as antidepressants
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Stimulants for depression: On the up and up?
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Individual placement and support, supported education in young people with mental illness: an exploratory feasibility study
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SU106. Investigating the Short- and Long-Term Benefits of Exercise in Early Psychosis
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A prospective cohort study of depression course, functional disability, and NEET status in help-seeking young adults
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Developmental Trauma is Associated with Behavioral Hyperarousal, Altered HPA Axis Activity, and Decreased Hippocampal Neurotrophin Expression in the Adult Rat
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Using New and Innovative Technologies to Assess Clinical Stage in Early Intervention Youth Mental Health Services: Evaluation Study
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Motivational interviewing to reduce substance use in adolescents with psychiatric comorbidity
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Technology-Enabled Person-Centered Mental Health Services Reform: Strategy for Implementation Science
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White matter tractography in early psychosis: clinical and neurocognitive associations
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Thoughts of death or suicidal ideation are common in young people aged 12 to 30 years presenting for mental health care
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The impact of alcohol and tobacco use on in vivo glutathione in youth with bipolar disorder: An exploratory study
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Correlates of Overweight and Obesity Among Adolescents With Bipolar Disorder in the National Comorbidity Survey–Adolescent Supplement (NCS-A)
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A transdiagnostic study of education, employment, and training outcomes in young people with mental illness
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Clinical staging models: From general medicine to mental disorders
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Topiramate and Metformin Are Effective Add-On Treatments in Controlling Antipsychotic-Induced Weight Gain: A Systematic Review and Network Meta-Analysis
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Youth mental health: we know where we are and we can now say where we need to go next
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Toward a Twenty-First Century Approach to Youth Mental Health Care: Some Australian Initiatives
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See all 208

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: Hickie, Ian B
Scott, Elizabeth M
Cross, Shane P
Iorfino, Frank
Davenport, Tracey A
Guastella, Adam J
Naismith, Sharon L
Carpenter, Joanne S
Rohleder, Cathrin
Crouse, Jacob J
Hermens, Daniel F
Koethe, Dagmar
Tickell, Ashleigh M
Sawrikar, Vilas
Scott, Jan
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: bronze
doi.org
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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Right care, first time: a highly personalised and measurement‐based care model to manage youth mental health

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