mental health disorders

A new screening strategy, YouthCHAT, is soon to be implemented in New Zealand to combat mental health disorders and risky behaviour in adolescents.

Mental health concerns and risky behaviour often arise during adolescence, including alcohol and drug use, physical inactivity, and sexual risk behaviours. In New Zealand, 25% of youth are affected by depression and anxiety, and over 50% engage in alcohol consumption by the age of 18 years. Notably, suicide is the leading cause of death for New Zealand youth aged 15-24 years, and second leading cause for those aged 10-14 years. For New Zealand’s indigenous population, rates of suicide are even higher.

Early detection and treatment of mental health disorders are crucial for youth. However, despite the availability of effective treatments, 75% of New Zealand’s adolescent population does not access primary care professionals to address mental health concerns. Untreated behavioural issues and mental health disorders can have personal costs on youth, their families, and local communities. A longitudinal study that followed children with mental illness found that as adults, those with mental illness had more time off work for sick leave, earned lower yearly salaries and had fewer monetary assets. Therefore, user-friendly screening tools are needed to ensure early treatment for these individuals.

Screening generally refers to testing an asymptomatic population for the presence of disease conditions, which if identified early, can lead to immediate intervention to reduce morbidity. There is sufficient evidence that screening can prevent adverse outcomes in drug abuse, alcohol addiction, and some mental health issues. In young populations, electronic screening may be an emergent technique for detecting behavioural issues as it provides consistent results, reduces primary care personnel time, and allows the individual to disclose sensitive information without fear of being judged.

A new initiative designed to screen youth for mental health disorders and risky behaviour has recently been discussed in Public Health Reviews. YouthCHAT is a youth-specific, self-administered risk behaviour and mental health e-screening program developed in New Zealand in 2015. Individuals can indicate areas they would like to receive help in, including depression, anxiety, exposure to abuse and substance abuse, as well as their readiness to change. Once completed, the individual clinicians can immediately access a summary report, allowing for a conversation between the two individuals and the shared planning of action. This approach engages youth and empowers them to have input into their management plans and method of intervention.

YouthCHAT is soon to be implemented in New Zealand, with an emphasis on the indigenous population. It is anticipated that the program will be associated with improved health and social outcomes through early identification of risky behaviour and mental health conditions. Early detection of these behavioural issues can lead to many downstream social and financial benefits, including improved physical health, reduction in school dropout rates, increased employment, decreased suicide rates, and a reduction in crime. For example, many incarcerated individuals practice risky behaviour and substance abuse. The average cost of keeping a New Zealander in prison is $250 per day. By focusing on early intervention of risky behaviour in youth, YouthCHAT can mitigate these issues that are often the basis for offending and incarceration. Helping one youth avoid a five-year prison sentence could save New Zealand $455,000.

In conclusion, opportunistic screening for mental health concerns and other risky behaviours during adolescence can prevent unnecessary morbidity and mortality, including suicide, and reduce the financial burden of these problems on patients, their families, and the community. Early detection and intervention will lead to improved health outcomes, especially for under-served indigenous populations.

Written by Neeti Vashi, BSc

Reference: Goodyear-Smith, F., Martel, R., Darragh, M., Warren, J., Thabrew, H., & Clark, T. C. (2017). Screening for risky behaviour and mental health in young people: the YouthCHAT programme. Public Health Reviews38(1), 20.

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