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Even in developed countries, access to and quality of mental health care lags way behind that for mainstream health care. 1 This gap is widest for young people, who have to deal with the full force of emerging mental and substance use disorders as they struggle to make the increasingly complex transition from childhood to independent adulthood. As we strive to scale up mental health services worldwide, 2 there is no better place to invest. 3
Mental illnesses are the chronic diseases of young people. 4 Seventy five per cent of mental disorders emerge for the first time before the age of 25. 5 There is a dramatic surge in incidence beginning after puberty, peaking in the early 20s. 5 It is a curious paradox that better physical health in young people has been accompanied by steadily worsening mental health. 6 7 8 A youth mental health system could reduce the long term financial and human costs associated with illnesses that disable and shorten the lives of so many young people.
Specific needs
Expertise in development is essential for working with children, young people, and their families, yet our workforce is not well equipped. Sweeping demographic changes over the past half century have fundamentally altered the nature of development for young people, posing more complex challenges and developmental tasks. 9 In developed countries at least, a period of emerging adulthood can now be distinguished from both childhood and truly independent adulthood. 9 10 Mental disorders, even of moderate severity, can delay or derail career plans and affect relationships with family and peers, which are vital for support during this transition. 11 Emerging adulthood has evolved its own culture and requires treatment models that differ substantially from those suitable for children and older adults. Similar challenges face other agencies, such as drug and alcohol, forensic, housing, and vocational services. 12
As with paediatrics, child psychiatry has focused on younger children, with attention declining from mid-adolescence. 13 14 This means that the surge of new morbidity between the ages of 15 and 25 is paired with the worst access to services 1 14 ; the system is weakest...