‘Most life-time mental health problems begin in mid-teens, early adulthood’

Most life-time mental health problems begin in the mid-teens and early adulthood, making easily accessible, non-judgemental services for young people critical to averting life-long struggles, youth mental health expert Professor Matthew Broome warned during his Wolfson Memorial Lecture.

Titled “In the Middle of Winter, an Invincible Summer: From Delusions to Early Intervention and Youth Mental Health”, the University of Birmingham professor’s lecture on 27 October continued a tradition that began in 2012, in honour of Lord Wolfson, the late founder of proud University of Cape Town (UCT) partner the Wolfson Foundation.

Presenting data on the age of onset of mental health disorders, Professor Broome stressed that the ages between 15 and 20 were particularly critical. Examples included substance use disorders (18–29 years), schizophrenia (15–35 years), and eating disorders (16–25 years). The age group was also at risk for anxiety disorders, although age of onset began as young as five.

“This is the time when the world revolves around the young person … [and] also the peak time for the onset of disorders.”

“This is the time when the world revolves around the young person. They might change their levels of clinical care from paediatrics to adults; they may move to independent living, to work, to university. So, a lot is happening and that is also the peak time for the onset of disorders,” he said.

Young people at risk

Broome went on to reiterate that rates of mental health problems are increasing dramatically among young people. The United Kingdom (UK) had seen significant increases in the number of referrals to child and adolescent mental health services, and he said it was likely “the same in Cape Town”.

There were also much higher self-ascription of mental disorder rates, including in undergraduates. Particular areas seeing increases included so-called internalising disorders. These included depression, anxiety, self-harm and eating disorders. In young women specifically, suicide and self-harm were also increasing.

According to a 2022 National Health Service (NHS) digital survey, rates of youngsters aged between 17 and 18 with a “probable mental disorder” also increased exponentially, from 10% in 2017, to one in every four, or 25.7%, in 2022.

“Of course, this is not just a UK problem. Mental health problems affect 10% to 20% of children and adolescents worldwide,” he said, pointing out the heightened risk for children and adolescents in low- and middle-income countries, who account for almost a quarter of the world’s population.

Principally, Broome said, interventions needed to be developmentally and culturally appropriate. At best, they would be co-designed with those they are intended to assist.

“Services should be accessible, with soft entry. So, not huge amounts of referral paper work, or phone calls, or general practitioners [having] to fight in your corner,” he said, adding that they should also be community-based, non-judgemental and non-stigmatising.

Benefits of early intervention

Using the example of the NHS in the UK to highlight the benefits of early intervention, Broome told attendees that the approach proved to be both beneficial to patients, and more cost-effective.

“A new model of care was needed [in the 1990s] to respond to early onsets of psychosis, and it needed to be found in medical interventions. The goals of early intervention psychosis services are to reduce the duration of untreated illnesses, maximise recovery, prevent relapse, and optimise acute treatment and quality of care,” he explained.

These efforts had produced a lot of research and scientific data, as well as health service valuations and economic analysis, he added.

“The UK context shows that early intervention … gives a better experience to people with mental ill-health and leads to low rates of suicide.”

“The UK context shows that early intervention seems to save the NHS money. It also gives a better experience to people with mental ill-health and leads to low rates of suicide,” Broome explained, adding that work was still ongoing on questions, including the length of time the gains would be maintained, and whether there were subpopulations in need of more care.

Introducing Broome at the start of the lecture, UCT Deputy Vice-Chancellor for Research and Internationalisation Professor Sue Harrison said the university and the Wolfson Foundation share a strong commitment to the pursuit of excellence in education and research.

“The Wolfson Memorial Lecture highlights key global research in areas with immense social impact,” she added.

Watch the lecture recording: