Health services and policy implications of staging models for high-risk states in youth mental health

Presentation First Author: 
Jai Shah

Introduction: After 20 years of multimodal investigations into high-risk states for severe and persistent mental illness, the original concept of linear progression towards or away from a specific full-blown disorder over time seems cloudier than ever. Meanwhile, young people continue to have difficulty accessing much-needed care. New ways of thinking about how and why early mental distress in young people sometimes evolves into a range of more discrete clinical entities are badly needed.

Objectives: This presentation will a) discuss how multiple lines of research have informed the evolution and development of staging models, b) describe ways in which newer staging models have been or can be operationalized in clinical service design and delivery, c) evaluate the systems and policy implications of such a service transformation, and d) consider how to communicate these issues to scientists, clinicians and health planners.

Approach: We will present varying definitions of high-risk states and staging models along with their differing implications for service design and health systems. These will be discussed in the context of examples such as ACCESS-Canada, a recently-formed national network for youth mental health service transformation. We will also explore how researchers, clinicians and policy-makers should conceptualize the clinical trajectory and development of mental illness in young people in the future.

Practice/Policy Implications: Young people with high-risk mental states can have a varying set of attenuated and sub-threshold symptoms. Over time, staging models have been updated to account for dropping conversion rates over time and the fact that conversion, if it occurs, is often not to the index disorder. Finally and of great importance, outcomes in those with high-risk states are poor even in those who do not ultimately develop full-blown mental illnesses.

Conclusion: Clinical and functional studies have provided many reasons for a recent shift towards a 'general' staging model of high-risk states. We will discuss what these findings might mean for research into the causes and course of high-risk states and youth mental health more generally. We will also propose ways in which health services can be re-organized to build on these observations, and the system-level considerations involved in such a transformation for projects like ACCESS-Canada.

Conference Name: 
Date of Presentation: 
10th Oct 2015
Type of presentation: 
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