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Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care?

International Journal of Mental Wellness Systems volume xiv, Article number:23 (2020) Cite this article

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Abstract

Background

Similar to other health intendance sectors, mental health has moved towards the secondary prevention, with the endeavour to detect and care for mental disorders as early as possible. All the same, converging evidence sheds new lite on the potential of primary preventive and promotion strategies for mental health of young people. Nosotros aimed to reappraise such evidence.

Methods

We reviewed the current state of noesis on delivering promotion and preventive interventions addressing youth mental wellness.

Results

One-half of all mental disorders offset by fourteen years and are usually preceded by non-specific psychosocial disturbances potentially evolving in any major mental disorder and accounting for 45% of the global burden of disease across the 0–25 age bridge. While some activity has been taken to promote the implementation of services dedicated to young people, mental health needs during this critical period are still largely unmet. This urges redesigning preventive strategies in a youth-focused multidisciplinary and trans-diagnostic framework which might early modify possible psychopathological trajectories.

Conclusions

Evidence suggests that it would exist unrealistic to consider promotion and prevention in mental wellness responsibleness of mental health professionals alone. Integrated and multidisciplinary services are needed to increase the range of possible interventions and limit the take chances of poor long-term effect, with besides potential benefits in terms of healthcare system costs. However, mental health professionals have the scientific, ethical, and moral responsibleness to indicate the direction to all social, political, and other health care bodies involved in the process of meeting mental health needs during youth years.

Background

Promotion, prevention and early intervention strategies may produce the greatest impact on people's health and well-beingness [1]. Screening strategies and early detection interventions may allow for more constructive healthcare pathways, by taking activity long before health problems worsen or by preventing their onset [2]. They as well permit for a more personalized care in terms of tailoring health interventions to the specific sociodemographic and health-related risk factors as well as activating interventions specific to affliction stage [3]. In this regard, the application of clinical staging models has been suggested to better wellness benefits, past addressing the needs of people presenting at unlike stages along the continuum between wellness and illness [4]. Despite challenging, reformulating health services in this perspective may increase prevention and early on intervention effectiveness, illness control and overall care, positively impacting on the wellness and well-existence outcomes of a broader population [five]. Not to exist overlooked, it may potentially reduce affliction burden and healthcare system costs [vi].

The need for implementing prevention and early intervention in youth mental health

Prevention and early intervention are recognized fundamental elements for minimizing the impact of whatever potentially serious health status. However, while representing a field of remarkable achievement, that of early on intervention in youth health is a target non completely accomplished even so [7]. This is particularly true for youth mental health. In fact, mental healthcare has been traditionally oriented to provide health benefits to developed populations during crisis events and major emergencies [8]. In this framework, mental health presentations to emergency settings in pediatric populations are somewhat frequent events [9]. Deinstitutionalization policies have only partially addressed this issue, also in light of the large variability worldwide in the implementation of community mental health services [10], especially for children and young adults [11].

Theoretical considerations about the opportunity to intervene in this specific age window in terms of mental health follow a number of evidence-based considerations. First, mental health is a fundamental component of the person's ability to function well in their personal and social life besides equally adopt strategies to cope with life events [12]. In this regard, early on babyhood years are highly of import, in light of the greater sensitivity and vulnerability of early on brain evolution, which may have long-lasting effects on academic, social, emotional, and behavioral achievements in adulthood [thirteen]. Second, near mental disorders accept their tiptop of incidence during the transition from childhood to young machismo, with up to 1 in 5 people experiencing clinically relevant mental health issues before the age of 25, 50% of whom being already symptomatic by the age of 14 [14]. Among people younger than 25 years old, mental health problems, especially anxiety and mood disorders, are the main cause of disability-adjusted life-years (DALYs), accounting for 45% of the global burden of disease, with problematic substance utilise including alcohol and illicit drugs being the chief risk factor for incident DALY (9%) [xv]. Third, nearly mental wellness services, as traditionally developed, have proven to be ineffective to provide healthcare during this disquisitional menses [16], with a modest employ of mental health services despite the high prevalence of mental wellness bug amongst immature individuals [17]. Too, following symptom onset, people aged 0–25 experience the greatest filibuster to initial treatment [eighteen]. This is mainly due to ii reasons. On one hand, young individuals, especially male, socioeconomically disadvantaged, and of indigenous minority, are less likely to found initial contact with mental health services and stigma represents a major barrier in this regards [19]. When they practise, they prove high rates of detachment [20]. On the other, significant delays in receiving care are besides attributable to the reduced power of services to speedily deliver specialist mental healthcare for youth in need afterward a first principal care consultation [21]. When treatments are finally offered, the majority are not evidence-based [16].

Based on prove summarized above, in that location is a pressing need to develop, or improve where nowadays, youth mental healthcare models which can implement prevention and early intervention strategies. While progress has been fabricated for psychotic disorders, likewise due to the successful application of an at-gamble mental state concept [22], this is still largely unexplored in the context of common mental disorders, such equally low, feet, substance abuse, and eating disorders [23]. In order to meet the need for early on intervention into childhood and immature machismo mental wellness difficulties, it is imperative to parallel redesign prevention and early intervention services for young populations, by promoting multidisciplinary collaborations betwixt different specialized professionals in an enhanced and integrated service of extended primary care [5].

The aim of this narrative review is threefold: (i) to update on the current debate on the at-risk mental state concept and the possibility of widening the clinical surface area of intervention beyond psychotic disorders; (ii) to review the part of psychosocial difficulties early on in life as potentially stable chance factors for poor mental health, and the extent to which they have been targets for early intervention; and (3) to report on the progress made then far in implementing collaborative and integrated services for youth mental health within the healthcare arrangement.

Methods

The current literature review is intended to bring together research evidence on early life risk factors detection, youth mental health service provision, and application of a clinical staging model by using a trans-diagnostic approach. In particular, the present work aims to emphasize the human relationship between these early on intervention components and offer new directions for clinical research into the full development of a youth-based model of mental healthcare focused on prevention.

Search strategy

A literature search was performed using electronic databases (MEDLINE, Web of Scientific discipline, and Scopus), using a combination of search terms describing run a risk factors, clinical staging, and multidisciplinary prevention and early interventions in youth mental wellness. Special attending was given to available research of the by 25 years every bit a major transition in the clinical label of the prodromal phase of major psychiatric disorders in youth has occurred during the by 2 to iii decades [21]. In addition, some research evidence gathered outside this search was reported, if considered appropriate by all authors.

Eligibility criteria

Studies were eligible for inclusion in this review if assessing preventing strategies in youth in a trans-diagnostic and multidisciplinary arroyo. Studies were excluded in they (i) did not assess the awarding of a clinical staging model for youth mental health in a trans-diagnostic framework; (2) did not investigate youth mental health service provision in a multidisciplinary framework; (iii) primarily assessed gamble factors and preventive strategies in older populations rather than youth.

Towards a trans-diagnostic clinical staging model to intercept a wider at-hazard youth population

Over the nineteenth century, the and so-chosen "prodromal state" (i.e. the period preceding the onset of astringent mental disorders), was seen as a stage characterized past low-intensity or low-severity symptoms not sufficient to justify a categorical diagnosis, but whose ineluctable progression to full-blown disorder was just a matter of time. Towards the end of the last century, the formulation of the "at-gamble mental state" concept [22] has represented a milestone in the development of a preventive arroyo to mental disorders, by overcoming the stagnant thought of inevitably ominous prognosis. This has dramatically loosened the deterministic approach to more severe mental disorders, such every bit schizophrenia, in favor of a more cautious arroyo to the potential futurity evolution of the condition in a psychosis-spectrum context where milder forms of the disorder and recovery are even so possible. After a period of struggle to translate this paradigmatic advance in more effective mental healthcare practices, mostly because of the restrictive application of notions of "take chances" and "transition" on the basis of positive psychotic symptom manifestation lonely [24], we are finally facing a new turning point. Research evidence has increasingly recognized that, in addition to transition to psychosis, longer-term psychotic disorder, or persistent sub-threshold psychotic symptoms, progression to persistent mood, anxiety, personality and/or substance apply disorders is also a very mutual outcome [25, 26]. This adds to the contained bear witness that during development risk factors may contribute to a range of psychopathologies, and early indicators of later gamble are often dimensional [27]. For instance, babyhood adversities seem to impact negatively on a number of disorders [28]. Thus, in social club to amend narrate pluripotent and trans-diagnostic developmental processes and bio-behavioral mechanisms that give rise to mental illness, cross-disciplinary approaches need to integrate, if not overcome, the traditional diagnostic approach.

In this regards, integrated youth mental health services for people who are still in the before stages of a mental disorder may benefit from a wider clinical staging model framework far across the limited ultra-loftier take chances (UHR) prototype for psychosis. In particular, a trans-diagnostic clinical high-risk mental state (CHARMS) paradigm may increment chapters to intercept a wider range of lower risk cases than those with adulterate psychotic symptoms only, including people with sub-threshold bipolar and borderline personality symptoms likewise every bit balmy-moderate low [22] (Fig. 1).

Fig. 1
figure 1

A trans-diagnostic clinical staging model to intercept a wider clinical loftier-risk mental state population

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Youth mental health: which targets for which interventions?

Neurodevelopmental changes occurring during youth brand information technology a catamenia of both vulnerability and opportunity for mental wellness. Research show indicates that a number of factors influence the person's mental health from before birth until early adulthood, later on which mental health can however be significantly modulated but to a bottom extent [29]. Meeting the child's physical (i.e. healthy nutrition), psychological (i.east. stable and responsive zipper relationships), and social (i.e. supportive and rubber environments) needs is key chemical element to support optimal encephalon development, emotional regulation, and higher order cerebral role, with long-lasting health benefits [thirty]. Conversely, adversities during pregnancy and early childhood such as inadequate care, neglect, and trauma, accept been shown to negatively impact on academic trajectories, psychosocial skills, physical resilience and the possibility of healthy aging [29, 31]. Also, depending on their nature, whether take chances or protective factors, such environmental determinants may differentially attune cistron expression and stress response, with enduring health effects [32]. For example, evidence from gene-surroundings interaction studies suggests that children carrying specific genetic variants are at increased risk for behavioral problems in later life, simply only when raised in dysfunctional families [33]. Similarly, regardless their severity, stressful life events produce the most 'toxic' effect on children'due south stress system, raising the risk of subsequent development of stress-related mental difficulties, when experienced in the absenteeism of a stable and supporting surround [34]. In this context, it appears particularly relevant the development of a secure attachment between the child and a protective chief caregiver, in social club to facilitate adaptive emotional and behavioral responses to stressful events [35]. In its absence, neurodevelopment may exist undermined, making that person more vulnerable to further environmental insults and subsequent development of both internalizing [36] and externalizing [37] behavioral problems, including anxiety, depression, substance misuse, maladaptive eating patterns, sexual run a risk behavior, and suicidality. The relation between attachment difficulties and youth psychological problems is nigh probable bidirectional, such that problematic behaviors during childhood and adolescence may also precipitate difficulties in the caregiver-child/adolescent attachment bond, or exacerbate preexisting dysfunctional patterns [38]. Research has shown that internalizing and externalizing disorders of childhood are associated with an increased likelihood to develop a psychiatric disorder later in adulthood [39]. Interestingly, stringent tests of homotypic (a disorder predicting itself overtime) and heterotypic (different disorders predicting ane another over time) prediction patterns suggest an increasingly developmentally and diagnostically nuanced picture, including but non limited to: (i) cross-prediction between anxiety and depression from adolescence to adulthood; (ii) adolescent oppositional defiant disorder, feet and substance disorders entirely accounting for the homotypic prediction pattern of depression overtime; and (iii) internalizing and externalizing psychopathology predicting psychosis-similar experiences and vice versa [40]. Overall, these findings highlight how single disorder-oriented trajectories offer limited prospects for preventive interventions. Instead, interventions addressing multiple co-occurring problems are more likely to impact positively on youth mental health, potentially interrupting the continuity between childhood internalizing and externalizing psychopathology that may besides co-occur with psychosis-like experiences on one manus, and psychiatric disorders in adulthood on the other. A large survey conducted by the World Health System (WHO) among 51,945 adults in 21 countries reported that eradication of childhood adversities, peculiarly those associated with maladaptive family functioning (e.g. parental mental illness, kid abuse, fail), would lead to a 29.8% reduction of any mental disorder lifetime, and an even higher reduction when considering exclusively adolescence- (32.3%) and babyhood-onset (38.2%) cases [28]. The possibility of preventing most i in 2 childhood-onset mental disorders is of crucial importance when considering that the feel of a mental disorder "kindles" a cascade of events which brand recurrence later in life more likely [41]. Thus, promoting selective preventive strategies supporting children's physiologic reactivity, cerebral control, and self-regulation through parenting- and classroom-based interventions, may correspond a massive preventive action and ensure the earliest possible access to intervention with a view of limiting the continuity of mental wellness problems from childhood through to adolescence and adulthood.

A summary of adventure factors and pluripotent pathological trajectory for mental disorders encompassing the youth prevention and early on intervention window is provided in Fig. ii.

Fig. 2
figure 2

Summary of take a chance factors and pluripotent pathological trajectory for mental disorders

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Mental health prevention and early intervention in youth: where is the evidence?

Promotion of youth mental health

Mental health promotion focuses on enhancing the strengths, chapters and resource of individuals and communities to enable them to increase control over their mental health and its determinants. Prevention, on the other hand, aims to reduce the incidence, prevalence and severity of targeted mental health weather [42]. In society to fill the handling gap for mental, neurological, and substance apply disorders worldwide, evidence-based guidelines developed by the WHO recommend that population level health interventions had an overall promotion focus. This is in line with the well-established continuum of care between interventions promoting positive mental health, interventions striving to prevent the onset of mental health disorders (primary prevention), and interventions aiming at early identification, instance detection, early handling, and rehabilitation (secondary and third prevention) [43].

Meta-analytic work strongly supports the effectiveness of youth prevention programs addressing child abuse [44], negative consequences of parents' divorce on children [45], substance abuse [46], and school-related problematic behaviors [47] in reducing rates of psychosocial difficulties later in life [48]. In this regard, multimodal preventing programs combining preschool intervention and family support have been associated to the most indelible beneficial effects on a number of social outcomes, including meaning amend overall bookish performances and lower delinquency and antisocial beliefs rates [49]. However, it is worth mentioning that promotion practices endure from unlike mental health policies and social and contextual determinants. For instance, some wellness and social domains such as education, housing, nutrition, and healthcare, have pervasive influence on low income settings, while lack of supportive environments and community networks may accept more than detrimental furnishings in urban areas with loftier population density or ethnic minorities [50, 51]. Most likely, promotion programs crave tailoring to the specific socio-cultural setting. Depending on its critical issues and what interventions are needed most, the implementation of effective programs goes through reorienting health services. Besides, dialogue between health research, health professionals, health service institution, and governments is of paramount importance, peculiarly to evangelize integrated and multidisciplinary deportment for the benefit of the unabridged community [fifty].

Primary prevention in youth mental health

Developmental model for chief prevention

Principal prevention strategies may be universal, selective, or indicated, depending on whether they target the general population, a sub-grouping of the population, or specific individuals, respectively [42]. Rather than being separate, they should exist seen as an integrated set of preventive interventions that go on throughout the neurodevelopmental stages of life also as the intensification of risk [52].

Universal prevention (pre-clinical stage)

Mental health universal prevention aims at promoting normal neurodevelopment. Even though there is no consensus on which might exist the pathophysiological mechanisms to be addressed during early development, promising findings propose that developmental anomalies and behavioral deficits observed during childhood may be, at least partially, modifiable [53]. A number of effective pharmacological and psychosocial interventions for universal prevention have been identified, including: (i) perinatal phosphatidylcholine [54] and N-acetylcysteine [55] administration to support infants' encephalon development and anti-inflammatory neuroprotection; (ii) lifetime omega-3 fatty acrid [56,57,58], vitamin [57,58,59], sulforaphane [lx], and prebiotic [61] supplementation to support good mental health by reducing neuroinflammation, oxidative stress, and microbiota dysbiosis; (iii) school-based behavioral interventions to minimize risk of bullying and peer rejection [62, 63] too as substance abuse [64, 65]; (iv) exercise training to support encephalon plasticity [66], structure [67] and connectivity [68] as well equally cerebral operation [69].

Selective prevention (clinical stage 0)

Selective interventions aim at preventing the manifestation of psychiatric symptoms, thus altering the developmental pathway to full-threshold disorders in the premorbid state. Recipients of these interventions are individuals whose chance of developing a mental disorder is significantly college than the rest of the population, while still beingness asymptomatic [42]. A number of take a chance factors accept been identified, including parental mental affliction [70], paternal age [71], maternal and obstetric complications of pregnancy [72, 73], flavour of birth [74], indigenous minority [75], immigration status [76], urban environment [77], infections [78], childhood adversities [28], vitamin D deficiency and malnutrition [79], low premorbid intelligence quotient [80], traumatic brain injury [81], and heavy tobacco [82] and cannabis employ [83, 84].

It is worth reporting that most risk factors are shared across multiple mental disorders, suggesting the poor validity of boundaries between diagnostic categories, at to the lowest degree at this stage [85]. Also, while some risk factors are hands correctible (due east.g. vitamin D deficiency) or technically preventable (due east.g. cannabis use, infections), other require restructuring the part of the youth mental wellness professional besides employing a core of paraprofessionals to piece of work more than intensively with a large population of at-risk immature individuals (east.one thousand. childhood adversities), and for withal others information technology is difficult to envisage programs ethically or practically sustainable (season of birth, urban environment) [86]. A few studies evaluated the effectiveness of prenatal and early infancy preventive programs for infants and children who may exist socially disadvantaged or potentially at risk [87, 88]. Results supported long-term positive effects of nursing domicile visits to expectant mothers and their families in hard social circumstances [87] also as schoolhouse educational interventions and home teaching to support depression-income families and their preschool children [88] in reducing kid abuse, neglect, and criminal behavior as well as improving the use of welfare and family socioeconomic status [87, 88].

To appointment, timing school-based mental health aid, assertiveness training, and stress and anxiety management have the greatest chance to prevent maladaptive beliefs and symptomatic manifestations [89]. Finally, while there is no clear research evidence favoring selective interventions in specific targeted populations, a promising strategy has been suggested to be the identification of those young individuals exposed to these risk factors who also have a family history of severe mental disease, in light of the per se higher genetic component for risk of mental disorders [90].

Indicated prevention (clinical phase ane)

Indicated interventions aim at the identification of those individuals at clinical loftier risk for the development of a mental disorder who are functionally impaired and no longer asymptomatic [42]. Psychosis studies have identified in the first 2 years post-obit the manifestation of functional impairment a menstruation of particular risk for transition to total-blown disorder [91], with about a third only in remission [92]. More recently, a shift towards a broader focus no longer confined to the psychosis risk identification has been suggested, in line with the increasingly clear show that pathways to mental disorders are pluripotent and trans-diagnostic [22]. This follows also the evidence that a so narrowed arroyo guarantees a limited detection, approximately 5%, fifty-fifty for those patients who will eventually develop a first episode of psychosis [93]. In this respect, complimentary evidence comes from a large meta-analysis that evaluated the impact of indicated preventive actions amid 4470 at-adventure students presenting with a range of bug including depression, anxiety, anger, general psychological distress, cognitive vulnerability, and interpersonal problems [94]. Intervention strategies included cerebral-behavioral, relaxation, social skills training, general behavior, social support, mindfulness, meditation, psychoeducational, acceptance and delivery therapy, interpersonal psychotherapy, resilience training, and forgiveness programs. Results suggested that indicated interventions have positive effects not only in reducing the presenting problem simply besides in improving other areas of psychosocial adjustment [94].

Indicated interventions are nonetheless preventive and aim at altering the trajectory of mental disorders. Inquiry evidence suggests that the development of services for indicated prevention has met the objectives of strengthening service appointment, reducing the duration of untreated illness, and liaising with secondary prevention interventions [42]. In particular, reducing the duration of untreated disease has been robustly shown to impact positively on the result of first-episode psychosis and schizophrenia in many ways [95]. Increasing evidence suggests a similar effect for other psychiatric disorders including major depressive disorder, bipolar disorder, panic disorder, generalized anxiety disorder, and obsessive–compulsive disorder [96]. Importantly, as some pre-diagnostic symptoms and neurobiological correlates are not specific for psychosis [97] and some undesired outcomes, such as decreased social functioning, quality of life, and occupational performance, are shared across mental disorders [98, 99], a hybrid strategy has been suggested in at-chance states involving symptom relief coupled to a reduction of transition [97]. In particular, command of symptoms and self-control of emotion and behavior every bit well as programs targeting poor social problem solving, low quality of social back up, interpersonal disharmonize, loneliness, and other social difficulties in at-adventure states may reduce the risk of progression to whatsoever mental health disorder, including bipolar disorder and depression [97].

Secondary prevention in youth mental health (clinical phase 2)

If patients progress to the manifestation of full-blown psychiatric symptoms, it is paramount to actively work towards securing early on and perchance complete recovery, past reaching a clinical and functional remission state. Secondary preventive strategies and early intervention services aim at mitigating the occurrence of negative prognostic factors such equally long duration of untreated disease, poor handling response, poor psychosocial well-existence and functioning, comorbid substance use, and high brunt on patients' families, with the last goal of preventing relapse or incomplete recovery [90]. In order to improve the effectiveness of early intervention in mental health, a Cochrane systematic review has confirmed the need for greater collaboration between main care sector and specialist mental healthcare services [100]. In this regard, 'consultation-liaison' and 'collaborative care' models seem to work better than the so-called 'replacement model', where main care physicians make unproblematic referrals to mental health services [100], for a number of youth-onset psychiatric disorders including depression [101,102,103,104], psychosis [105,106,107,108,109,110,111,112,113,114,115,116,117], bipolar disorder [118, 119], and panic disorder [120, 121], with promising bear witness for generalized feet disorder, social phobia [122], and somatoform disorders [123].

These multicomponent intervention programs involve the commitment of pharmacological and psychosocial interventions, as well equally psychoeducation and skills training. However, disappointing bear witness from studies of the consequence of collaborative care on depression signal that the clinical improvement may not be maintained afterward discontinuing the multidisciplinary handling [101]. Thus, one may speculate that discharging immature people to principal care or generic mental health services, which are not designed to aid young populations in the early stages of a mental disorder, is likely to result in the erosion of the initial advantages of the collaborative care, thus non changing the trajectory and outcome of the condition. In the absenteeism of studies assessing the longer-term efficacy of such interventions, peculiarly in preventing poor outcome, treatment disengagement, and relapse, circumspection is being chosen [90].

Tertiary prevention in youth mental wellness (clinical stage iii)

Tertiary prevention represents the last opportunity to mitigate the bear on of mental wellness problems in youth. In fact, following the manifestation of a first episode of astute psychiatric symptoms, some patients may not reach full recovery, being still symptomatic or functionally impaired. Third preventive strategies aim at addressing treatment resistance, poor psychosocial wellbeing and performance, comorbid substance use, and loftier burden on patients' families, with the final goal of preventing multiple relapses and illness progression [90]. While the biological evidence for an association between multiple relapse and further deterioration is conflicting [124], inquiry suggests detrimental psychosocial and functional consequences of each relapse [125, 126]. The absenteeism of validated interventions to prevent multiple relapses highlights the limited protective effect of psychopharmacological treatments in the long-term, urging the development of new strategies to avoid chronicity (clinical stage 4).

A summary of promotion and preventive interventions in youth mental health is provided in Table 1.

Table i Promotion and preventive strategies in youth mental health

Full size tabular array

Towards the evolution of integrated and multidisciplinary services for the young population

Over the last decade, reforming youth mental wellness services in the perspective of integration and collaboration between dissimilar healthcare professionals has gained increasing interest [127]. Parallel, early on intervention models, initially designed to assist people with psychotic disorders, have expanded their area of intervention to mood, personality, eating, and substance use disorders [128]. Thus, information technology has get increasingly possible to offer multidisciplinary and integrated healthcare to young people below the age of 25 with a diverseness of mental wellness difficulties besides as support their families.

In the Usa, the Massachusetts Child Psychiatry Access Project (MCPAP) promoted the creation of a statewide service favoring collaborations between primary intendance practices and specialized child and adolescent psychiatry services. MCPAP has a wide expanse of intervention including attention deficit hyperactivity disorder, depression, feet as well as initial psychopharmacological handling [129]. Studies accept shown that virtually primary intendance practices have enrolled in the program, increasing immature individuals' access to psychiatric services and overall satisfaction [130]. With the aim of productively integrating and enhancing collaborative care at all levels of prevention, the Massachusetts Mental Health Services Plan for Youth (MHSPY) has also implemented home-based integrated clinical interventions to assist severely impaired youth with mental, social, and substance use problems too equally their families in the community. Studies have shown benefits of MHSPY interventions in terms of higher psychosocial functioning and family satisfaction as well as lower burden on services and take chances to self and others [131].

In Australia, a 2006 government-funded initiative led to cosmos of 'Headspace', a multidisciplinary and integrated service offering early intervention for 12–25-year-one-time people with emerging mental health difficulties. Headspace has a broad area of intervention including mental health, physical health, vocational and educational support, and substance apply [132]. In a decade, cheers to the creation of 'communities of youth services' (CYSs), Headspace has seen growing the number of its centers from ten to more than 110, granting access to services to almost 100,000 young people per yr, including vulnerable, marginalized, and at-risk groups [eight]. An independent evaluation of Headspace has shown positive effects of the service in terms of reducing suicide ideation, self-harm, and number of absent schoolhouse or work days [133].

This healthcare model is transferred to other countries at an increasingly rapid rate. In Ireland, services called 'Headstrong' and 'Jigsaw' have developed, proving to be effective in facilitating access to community care to people anile 12–25 with emerging mental health difficulties [134]. In the Uk, a youth-based mental health service called 'Youth space' has implemented integrated health benefits for people aged 0–25 years in the Birmingham catchment area [135]. Similar models have been developed or under construction in Denmark, Israel, California, Canada (the Access, Adolescent/young adult Connections to Community-driven Early on Strengths-based and Stigma-free services), British Columbia ('The Foundry' model), and the netherlands (@ease) [eight]. Interestingly, research is following suit, with programs moving from the early identification of states immediately preceding psychosis onset in belatedly adolescence or early adulthood to the investigation of earlier phases of disease in vulnerable children and younger adolescents (east.g. London Child Health and Development Study) [136].

In summary, a mix of services is offered amid these models of care, in club to target mental wellness and beliefs, situational issues, concrete or sexual health, alcohol or other drugs apply, and vocational bug. Depending on the presenting business organization, the proportion of each delivered service can vary every bit well as the main service provider (general practitioner, psychologist, allied mental wellness etc.) and funding source [137]. Moreover, elements indicating best practice accept been identified, including being highly accessible (affordable, convenient, timely, non-stigmatizing, flexible, inclusive, and awareness raising), adequate (youth-friendly, confidential, respectful, engaging, responsive, competent, and collaborative), advisable (early on intervention focused, comprehensive, developmentally-appropriate, suitable to early stages of illness, suitable to complexity of presentation, testify-based, and quality assured), and sustainable (community-embedded, integrated inside a national network, finer managed, abet for young people'due south wellbeing). These elements correspond a framework to exist used to inform futurity development, performance indicators, and standards of care [138].

Even though the topic is non covered in this reappraisal, for the sake of abyss Fig. 3 shows the next steps that would be required to vertically and horizontally integrate this enhanced model of primary care with more specialized and intensive services as well as other components of the health and social organisation.

Fig. 3
figure 3

Vertical and horizontal integration of the enhanced model of master care for mental health

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Conclusions and future directions

In social club to guarantee youth a healthy mental development through promotion, prevention, and early interventions, research testify supports the implementation of healthcare systems integrating mental, primary, and social care [128]. The contempo implementation of mental wellness services for the 0–25 age bridge [8] poses new questions nearly what is needed now for this model of care to fulfill its potential. The continuity of youth mental health needs from an early age seems to go across the boundaries of what falls within the mental wellness professionals' competences and duties, putting at stake the epistemological status of psychiatry. The mental health care sector has among its prerogatives the provision of effective interventions from early on stages of illness to long-lasting conditions. However, it is increasingly clear how crucial is to evangelize sustained early intervention across all potential stages, including the preclinical one, in order to avoid intermittent back up and not to lose initial progresses. So, what do mental health professionals have to do? Medicalize potentially serious problems at the preclinical phase? Potentiate the social management of at-chance conditions? Both? In the mental health field, attempts of reductio at unum have left much to be desired in all ages, highlighting the greater complexity of the question. The contempo debates about renaming mental health conditions or recognizing new ones on the footing of research bear witness, far from being a mere hermeneutic or linguistic upshot, underline the difficulty of managing what, through decades of clinical research, is emerging beneath the tip of the iceberg [139]. Promotion and prevention in mental health are not necessarily responsibility of mental wellness professionals alone. Inquiry evidence summarized in this review suggests that wellness researchers and professionals also as wellness service institutions and governments accept to join forces to deliver integrated and multidisciplinary actions in mental wellness, peculiarly in the early steps of the prevention chain. Mental health professionals accept anyway the scientific, ethical, and moral responsibleness to orient social, political, and overall health care actors involved in promotion and maintenance of mental health condition.

Availability of data and materials

Not applicative.

Abbreviations

Access:

Adolescent/young developed Connections to Customs-driven Early Strengths-based and Stigma-free services

CHARMS:

Clinical high-gamble mental state

CYSs:

Communities of youth services'

DALYs:

Disability-adjusted life-years

MCPAP:

Massachusetts Kid Psychiatry Access Projection

MHSPY:

Massachusetts Mental Wellness Services Program for Youth

UHR:

Ultra-high risk

USA:

Usa of America

WHO:

Earth Health Organization

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Acknowledgements

We thank Professor Mario Maj for his comments on a draft.

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No funding was received for this manuscript.

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Affiliations

  1. Section of Psychiatry, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134, Verona, Italia

    Marco Colizzi, Antonio Lasalvia & Mirella Ruggeri

  2. Department of Psychosis Studies, Found of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, United kingdom

    Marco Colizzi

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All authors co-wrote and edited the manuscript. MC provided leadership for decisions of content, framing, and style and led the creation of the Figures and Table. All authors read and approved the final manuscript.

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Correspondence to Marco Colizzi.

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Colizzi, M., Lasalvia, A. & Ruggeri, M. Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care?. Int J Ment Health Syst 14, 23 (2020). https://doi.org/x.1186/s13033-020-00356-ix

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  • DOI : https://doi.org/10.1186/s13033-020-00356-9

Keywords

  • Youth mental health
  • Promotion
  • Prevention
  • Early intervention
  • Multidisciplinary intendance
  • Trans-diagnostic model

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