from YAPRap December 2002
by Sherrill Spears, Illawarra Area Health
Major mental health problems such as depression, anxiety, psychosis and substance misuse frequently have their onset during mid to late adolescence and early adulthood.
Young people's mental health is as important to their development as their physical health. Mental disorders such as depression and psychosis impact greatly on the young person, their family and social networks. These disorders affect the young person's capacity to mature and accomplish developmental tasks, especially those relating to social development and independence. They impact upon thinking processes, emotions, perceptions, motivation and confidence, resulting in difficulties in learning, problem solving and achieving vocational goals. Mental disorders impact on schooling and other education, employment, the ability to cope with life situations and transitions, relationships and the capacity to enjoy normal activity.
Many young people have more than one mental health problem, for example young people with first episode psychosis often also experience depression and anxiety. Young people with eating disorders often experience depression. Antisocial problems may reflect aspects of depression in some young men. Hazardous use of alcohol and other drugs is strongly linked to the prevalence of mental disorders, including depression and psychosis, in young people. Suicide and self-harming behaviour are also linked to mental disorders.
Adolescence and young adulthood are periods of significant change and development that present opportunities and challenges. Stress is commonly experienced by young people during this time. Mental disorders such as depression or psychosis can exacerbate these feelings of stress in young people.
There are family, school and individual factors that assist young people to negotiate the challenges associated with this period, for example feeling close to and cared for by their families and having a sense of belonging at school.
Young people may also be disturbed by recent or post experiences of trauma and this increases the likelihood of their developing a range of problems that may continue into adulthood.
There are gender differences in the main types of problems that young people report having experienced. For example, males are more likely to engage in risky behaviours, whereas females are more likely to have experienced or witnessed physical or sexual abuse.
Use of mental health services by young people
Young people tend to be poorly informed about mental illness, including depression, anxiety and psychosis. When they experience a mental health problem they tend to seek help from family and friends or try to sort the problem out themselves. Australian studies suggest that only a very small proportion of young people will seek professional help from mental health services.
There are many reasons why young people do not access mental health services. Discrimination against people with mental illness is high, preventing help seeking behaviour. Many young people find mental health services are not culturally or youth friendly, and may not see them as relevant to their needs. Young people seeking help may be turned away from mental health services, as their problems may not be seen as serious enough. Mental health staff may have difficulty in distinguishing emerging mental health problems from normal adolescent difficulties. The pathways to effective care may not be clear for young people and their families and multiple contacts with the health system may be experienced prior to receiving appropriate care.
Young people may be in contact with other health services, for example general practitioners, community health or youth health. Australian studies suggest that children and adolescents with mental health problems were more likely to present to non-mental health agencies.
This provides opportunities for early recognition, intervention and referral. Collaborative links between mental health services and other services which young people access need to be strengthened to improve access to mental health services
Development of mental health problems in young people
Before a mental disorder develops, young people may experience a number of signs and non-specific symptoms that may indicate "something is not quite right". These signs and symptoms are not specific to a particular disorder. These changes in mental state could progress to a number of different problems, for example depression, psychosis, bipolar disorder, anxiety or a reaction to a crisis situation.
Young people experiencing these symptoms may not necessarily go on to develop a mental disorder, and it may be difficult at this early stage to ascertain whether the signs and symptoms are part of normal adolescent development or whether they are the beginning of an illness.
Because the symptoms evolve over time it is important to engage these particularly vulnerable young people, to provide support and access to services according to their changing needs, and to be seen as a source of help. Intervention may be indicated when the young person is known to be at increased risk of developing a mental disorder, for instance young people whose parents have a mental illness, or young people failing at school or at risk of homelessness.
A key principle of working with young people is the recognition of early warning signs or symptoms of emerging problems, which can be difficult.
Signs to look out for include:
- Reduced concentration and attention
- Reduced drive, motivation, lack of energy
- Depressed mood
- Sleep disturbance anxiety
- Social withdrawal
- Suspiciousness
- Deterioration in previous functioning
- Irritability
(It is important to note these features may be found in a range of developing mental health problems including depression and related disorders).
Depression and first onset psychosis
Depression has been identified as one of the major public health problems worldwide for the 21st century. Up to one in four young people will experience one or more episodes of major depression before they reach 18 years. First onset psychosis affects more than one percent of young people. Most of these young people do not receive treatment for up to two and a half years. The longer the delay to treatment for young people affected the worse the outcome.
Depression and first onset psychosis:
- Commonly have their first onset during late adolescence or early adulthood
- Are often preceded by identifiable warning signs
- Can recur throughout adult life
- Can have a serious impact on the young person's social, educational, emotional and vocational development
- Can have a major impact on the young person's family functioning
- Are commonly associated with serious risk factors
- Are linked with hazardous substance use and increased risk of suicide.
Notes
Opinions: are the author's and not necessarily YAPA's.
Be careful!
YAPA and the author took reasonable care to ensure that this information was correct at the time of publishing (above). The author/s may have no health qualifications (unless stated), and information provided is general - it is not specific advice. Do not rely on it - check with other publications and authorities and if necessary get qualified professional advice for your situation.
