Youth consultation-liaison psychiatry: A commentary

Everyone who works in public mental health services has experienced the jarring discontinuities in care that can occur when a patient moves from a child and adolescent care model to an adult service, with the move triggered not by the patient’s changing needs but simply by leaving school or turning 18. Moves towards a youth mental health model encompassing (say) ages 12–25 are therefore generally welcomed, though they raise old arguments in new guises about who should be the primary beneficiaries of these services. In the midst of the complex and hotly contested debate about whether such services should primarily treat high-morbidity, low-prevalence disorders, such as psychosis, or high-prevalence conditions, namely mood and anxiety disorders and substance use disorders, another very important group is in danger of being sidelined – young people with chronic medical illnesses.

This group is the welcome focus of the article by Allison et al. (2013), which asks whether the transitional youth health model developed by McGorry (2007) can be adapted to consultation-liaison psychiatry services working with young people. As they note, specialist medical clinics have a similar structural problem, with a pronounced child/adult divide that is not easily traversed by adolescents with chronic illness. In a parallel development youth medical clinics, comparable to the Early Psychosis Prevention and Intervention Centre (EPPIC) and headspace programs in mental health, have been proposed, and are already operational in some areas. The authors point specifically to the youth diabetes clinic in Westmead, Sydney, Australia as a successful example of a successful youth clinic.

Without being unduly prescriptive, the group makes the case for establishing links between youth medical clinics and emerging youth psychiatry services. I would have liked more detail on how these links might be established, given that headspace centres are typically not co-located with hospitals. For example, there are four headspace centres currently operating to service 4.5 million Sydney residents, and of these only two are near medical facilities (National Youth Mental Health Foundation, 2013).

Type 1 diabetes is the paradigmatic childhood-onset chronic medical illness with high psychiatric morbidity repeatedly referenced by the article, and mention is also made of cystic fibrosis, paediatric cancers, renal disease and congenital heart disease. However, the authors do not discuss anorexia nervosa, an adolescent-onset mental illness with high rates of medical morbidity, although this is a condition that would be especially suited to their proposed combined youth health model (Hart et al., 2011; Norrington et al., 2012).

Allison and colleagues (2013) are to be commended for highlighting the mental health needs of a vulnerable group of people – adolescents and young adults with chronic illness. They have drawn our attention to the parallel evolution of systems of care for young people with mental health difficulties on the one hand, and for young people with chronic medical illnesses on the other, and the risk that a large group of people with both sets of problems may not receive coordinated care. I would like to see the group go on to propose models for strac and readily disseminated services for young people with both medical and psychiatric needs.

See Viewpoint by Allison et al., 2013, 47(7): 613–616