BACKGROUND:Trans and gender diverse (trans) young people experience higher rates of physical and mental ill-health due to chronic exposure to gender minority stress. Consequently, trans young people report higher health and mental healthcare service utilisation. Disconcertingly, negative experiences of healthcare services are prevalent among trans young people, especially those with additional marginalised identities and backgrounds who experience multiple forms of marginalisation. Patient-reported experience measures (PREM) are auseful tool for improving patients' healthcare experiences however existing PREMs are not relevant, appropriate, nor inclusive of the unique healthcare experiences of trans young people, especially those facing additional forms of marginalisation. OBJECTIVE:This study will co-develop and validate a PREM for trans young people aged 12 to 25 years attending health and mental healthcare services. This PREM will capture how healthcare experiences should affirm all aspects of trans young people's identities in health and mental health services, including but not limited to their gender. DESIGN:Underpinned by a 'co-production' framework, the proposed study comprises four stages informed by a Lived Experience Advisory Group (LEAG) made up of eight trans young people from across Australia. Stage 1 is a scoping review of qualitative studies exploring the experiences of marginalised young people using healthcare services. Stage 2 is semi-structured, one-to-one interviews with multiply marginalised trans young people aged 12 to 25 years in Australia (n = 30) and healthcare professionals of trans young people in Australia (n = 30). Candidate PREM items generated from Stages 1-2 will be appraised in a multi-stakeholder modified e-Delphi Consensus Survey (N = 90; Stage 3) comprising multiply marginalised trans young people (n = 30), healthcare professionals (n = 30), and parents/caregivers of trans young people (n = 30). Lastly, in Stage 4, PREM items will be reviewed by trans young people in two cognitive debriefing focus groups (N = 14) to improve clarity, understandability, and interpretation. DISCUSSION:This study will co-produce and validate a PREM to effectively measure the quality of trans young peoples' experiences utilising health and mental healthcare services. The PREM will subsequently be implemented into integrated youth health services as part of a multi-staged quality improvement project evaluating an integrated gender service model of care operating in Victoria, Australia. PATIENT OR PUBLIC CONTRIBUTION:The Whole of Self Affirming Care Lived Experience Advisory Group together with trans members of the research team in designated peer and non-peer research roles have contributed to the design of the present study protocol and corresponding manuscript. These individuals will also contribute to analysis, interpretation, and write-up of all subsequent data and outputs.

OBJECTIVE:The authors aimed to assess return on investment (ROI) in the implementation of individual placement and support (IPS) for employment in Norway. METHODS:A four-state, 4-year Markov model was constructed to explore the costs and benefits of IPS implementation for 561 new recipients (ages 18-40) of a time-limited, health-related rehabilitation welfare benefit. Data were from multiple sources, including a difference-in-differences analysis of longitudinal registry data, detailed IPS resource use and cost data, and the literature. The primary outcome was ROI, from societal and public-purse perspectives, compared with outcomes in areas in Norway without IPS. RESULTS:Net economic benefits of 2025 international dollars (Int$) 2.6 million and Int$240,000, equivalent to ROIs of 4.76 and 1.34, were generated from societal and public-purse perspectives, respectively. Of the target population, 9% received IPS per year, at a cost of Int$700,000, equal to 67.8 additional full-time equivalent (FTE) years of work if employment gains were sustained over 4 years. For each additional FTE year of work, 33.1 work assessment allowance (WAA) recipients would need to receive IPS. The most sensitive model parameter, WAA benefit, would have to be reduced by 24% for IPS not to have a positive ROI. CONCLUSIONS:Even under conservative assumptions, the addition of IPS to supported employment approaches is likely to have a positive ROI from societal and public-purse perspectives in just over 1 and 3 years, respectively, even before broader benefits, such as impacts on health services utilization and reduction in the use of alternative supported employment services, are considered.

PURPOSE:This project aimed to develop the Individual Placement and Support (IPS) Workforce Development Framework to address challenges in IPS workforce availability, capacity, and capability in headspace centres across Australia, with the goal of improving vocational recovery outcomes for young people with mental ill-health. METHODS:A mixed-methods approach informed the development of an IPS Competency Framework and an aligned IPS Workforce Development Framework. Data were collected through workforce surveys, focus groups, interviews, and a literature review. Participants included IPS vocational specialists, supervisors, headspace centre and lead agency managers, and experts from the broader vocational and IPS sectors. A comprehensive options paper and Theory of Change guided the design of the IPS Competency Framework and IPS Workforce Development Framework. RESULTS:The workforce assessment revealed capability gaps, variations in recruitment practices, concerns about career pathways, and staff retention issues. Considerable diversity in vocational specialists' backgrounds and experience, along with a lack of clearly defined competencies for the role, was also apparent. In response, an IPS Competency Framework was developed outlining six core competency domains and four foundational values necessary for IPS vocational specialists working with young people with mental ill-health. The IPS Workforce Development Framework defines flexible, scalable strategies such as training and credentialing, peer-to-peer learning, strengthening recruitment processes, and career pathways, aligned to the identified competencies. CONCLUSION:The competency-based IPS Workforce Development Framework offers a comprehensive, system-level response to workforce challenges and marks an important step towards strengthening the IPS workforce in Australia. Ongoing evaluation will be essential to refine its implementation and improve IPS delivery for young people.

Youth mental ill-health is rising globally, while climate change is intensifying distress, uncertainty, grief, and disaster-related trauma among young people. Existing mental health systems remain largely reactive and clinically oriented, while disaster responses are often short-term and crisis-focused. This leaves a major gap in care for the chronic, collective, and climate-related dimensions of distress. This paper proposes Environmental-action Social Prescribing (ESP) as a distinct and emerging model of care that connects young people with meaningful environmental action through structured, supported pathways. Drawing on evidence from social prescribing (including green and blue social prescribing), nature-based interventions, interventions for climate/eco-distress and environmental engagement programs, we outline the rationale, active ingredients, system and policy requirements for ESP. Using three case studies, we argue that ESP requires three key elements: effective models of mental health care, supportive ecosystems that enable sustained engagement, and cross-sector infrastructure and system capacity. Together, these elements can extend traditional social prescribing, in the context of climate-related distress and the need for more widespread environmental action, by combining emotional validation, social connection, practical coping, meaning-making, agency, and collective environmental action. Although ESP is not yet established as a formal youth mental health care model, it represents a unique opportunity to address both youth mental health and planetary challenges. Realising this opportunity will require targeted investment in model development, evaluation, workforce capability, community infrastructure, and policy integration. ESP could support a generation of psychologically resilient, socially connected, and environmentally engaged young people.

Introduction Individuals experiencing moderate to severe mental illness have low rates of workforce inclusion, with a consequence of high welfare dependency, affecting both societal costs and health. Individual Placement and Support (IPS) is an approach to supported employment where the goal is to help people obtain jobs on the open rather than sheltered labour markets. Despite multiple randomised controlled trials (RCTs) indicating that the IPS model enables employment better than treatment as usual, with widespread adoption in some jurisdictions, the broader impacts of this large-scale implementation on mental health, quality of life and social functioning remain unknown.Methods and analysis Between 2012 and 2019, Norway introduced IPS through both local and national government projects. This study assesses the social and economic benefits of the implementation of IPS using Norwegian registry data, focusing on 18–45-year-old people receiving specialist mental healthcare, and who did not have steady employment at treatment start. Instead of assessing IPS efficacy in an RCT design, we use a naturalistic study design, evaluating IPS effectiveness by comparing aggregate population-level outcomes over time between areas where IPS was not available.In work package (WP) 1, we mapped the availability and implementation of IPS across Norway. This involved analysing information on funding, resource and capacity levels to understand how IPS had been rolled out across the country. While completed, we include a description of WP1 here, as it informs WP2 and WP3. WP2 is an effectiveness evaluation investigating the population-level outcomes of implementing IPS, focusing on health, mortality, quality of life and social functioning. Finally, in WP3, we assess the financial implications of implementing IPS from a public purse perspective, synthesising data on resource use and costs of implementation with data from WP2.Overall, we will examine the societal effects of IPS implementation on employment, welfare dependency, mental healthcare use, emergency care visits, self-harm and suicide, general mortality, crime and victimisation. Emphasis will be on long-term outcomes, and we will model the economic consequences of IPS. This study aims to inform policy making and strategies for implementing IPS at scale.Ethics and dissemination This is an effectiveness study using registry data. The Regional Committee for Medical Research Ethics Northern Norway, REK North has approved the use of registry data without informed consent for this project (approval number 134553).The findings will be disseminated both in academic peer-reviewed journals, directly to informants in WP1, to the public through media and the project website, and at relevant conferences and seminars for specific relevant target groups.Trial registration number Not applicable

OBJECTIVE:To prepare evidence-based guidelines on psychosis prevention. METHODS:We reviewed evidence on risk factors for/age at onset of psychosis, tools to assess clinical high-risk of psychosis (CHR-P), transition rates, risk calculation/ethical considerations around risk communication, CHR-P biological/clinical correlates, efficacy/cost-effectiveness of interventions/psychosis prevention services. The World Federation of Societies of Biological Psychiatry framework was used to grade evidence regarding interventions/services, elaborating guidelines with evidence-/consensus-based clinical recommendations to prevent psychosis in CHR-P subjects. RESULTS:At the service organisation level, (i) psychosis indicated prevention services might be implemented in close collaboration with early intervention services for psychosis to minimise duration of untreated illness, (ii) intake age criteria should be between 14 to 35, (iii) services should allow access to persons with cannabis use disorder. At the assessment and risk communication level, in clinical settings: (iv) staff in mental health services should be trained in administering/rating CHR-P assessment tools, (v) administer them, (vi) be trained in using/interpreting risk calculators, and (vii) in communicating risk, (viii) only use validated risk calculators, keeping a human-to-human interaction. Also, (ix) prevention services should assess comorbid mental disorders. At the intervention level: (x) staff should offer treatment for abstinence from cannabis, (xi) offer evidence-based treatment for comorbid mental disorders, and (xii) offer treatment for CHR-P based on patient preference, following the 'first do no harm' principle. CONCLUSIONS:Prevention services should be implemented, including interventions for cannabis use, reducing the duration of untreated psychosis, and treating comorbid mental disorders.

BACKGROUND:Many young people with first episode psychosis (FEP) experience challenges in key areas of social inclusion, including housing, finances, employment or education, and social relationships. However, there is diversity in these challenges, and it is unclear how social inclusion relates to potentially modifiable treatment factors such as social cognition. Here we aimed to identify distinct social inclusion profiles using cluster analysis and examine their associations with social cognition and other clinical factors. METHODS:145 young people (aged 15-25) who had experienced a FEP completed assessments of demographics, clinical symptomology, social inclusion, functioning, quality of life (QoL), and social cognition. K-means cluster analyses identified social inclusion subgroups. Kruskal-Wallis and Wilcoxon rank-sum post-hoc tests were used to compare subgroups on psychosocial factors and multinomial regression models were used to examine whether social cognition was associated with the subgroups, controlling for clinical factors. RESULTS:Three clusters emerged: low inclusion/low participation (LI-LP), moderate inclusion/low participation (MI-LP), and high inclusion/high participation (HI-HP). Social cognition was not associated with subgroup membership. LI-LP had greater depressive and less expressive negative symptoms than both other subgroups, and more severe motivation/pleasure negative symptoms than HI-HP. CONCLUSION:Distinct FEP subgroups with varying subjective and objective social inclusion, shaped by external psychosocial and clinical factors were revealed. The findings highlight the need for holistic and personalised care to improve social inclusion for individuals with FEP and suggest that targeting depressive and motivational negative symptoms may be potential avenues to achieve this.

This narrative review probes the future trends of psychiatry from the perspectives of professionals working in the field of early intervention for psychosis and youth mental health. The review is co-constructed by a diverse group of clinicians and researchers, including those with lived experience, working in high- to low-resource settings in the Asia-Pacific. Grounded in the consideration of psychiatry as a medical discipline. When the early intervention lens is applied to the state of psychiatry itself, several 'at-risk' factors have been observed: dilution of the doctor-patient relationship, lack of a robust integrated model of the human person and psychopathology, increased commercialisation, excessive reliance on other professionals, disconnection of knowledge generation and transmission, and tension between the healing and public safety roles of psychiatry. The complexity of mental illness, coupled with high stigma and low resources (even in relatively affluent populations), continues to undermine the proper functioning of psychiatry as a medical speciality. These challenges are likely to intensify in the future. Psychiatry as a profession needs to consolidate a robustly integrated medical approach to mental illness that resists splitting into 'biomedical' and 'psychosocial' perspectives, in the form of a biopsychosocially-informed medical psychotherapeutic practice. It will need to work with other stakeholders in the broader landscape of public mental health without diluting the healing roles in treating mental disorders. Behind a number of recent changes, the 'invisible hand' of the market economy is potentially driving psychiatry towards more inequity and escalating costs. Some of these have been fuelled by decreased effectiveness of the conventional academic platform and the rise of new information platforms that are increasingly challenging to manage. A thoughtful, prudent, and coordinated approach by the profession is essential in ensuring a healthy trajectory for the future of mental health care.

Tertiary students have been recognised as a high-risk population for psychological distress yet, in Australia, have been overlooked in population-level surveillance, health service provision and mental health policy. This study sought to explore trends in self-reported psychological distress and general mental health of tertiary students compared to their non-student working peers in Australia from 2007 to 2022— a timeframe which spans the pre-, mid-, and immediate-post-COVID time periods. The Household, Income and Labour Dynamics in Australia (HILDA) Survey was used as a basis for this study. Focusing on participants aged 18 to 35 from survey waves spanning 2007 to 2022 (average n = 4415 per year), participants were categorised into three groups: working only, tertiary students and working, and tertiary students only. Psychological distress and general mental health were measured using the Kessler-10 scale and the Mental Health Inventory-5, respectively. Weighted regression models compared outcomes between students and non-students. Psychological distress and poor mental health have risen among young Australians, with the sharpest increase since 2019. Tertiary students, especially those studying only, showed significantly higher distress and poorer mental health than working peers. Although adjusting for sociodemographic and socioeconomic covariates attenuated the associations, the higher distress levels in students persisted post-2019. Loneliness, long-term disabilities, and poor general health were correlates of poor mental health across all groups. Findings highlight the need for targeted care models for tertiary students, including enhanced campus mental health support and screening services, financial support, social connection programs, and digital health solutions.

Background Employment is recognised as a fundamental human right. Still, many people experiencing severe mental illness are outside the workforce. Appropriate employment has several benefits for mental health and is central to recovery and citizenship. Individual Placement and Support (IPS) integrates treatment and employment support and is an evidence-based model for supporting people experiencing severe mental illness to gain and maintain employment. Employment specialists are front-line workers of IPS. In Norway, the implementation of IPS is in a later phase and employment specialists are employed outside health services. This study explores and describes employment specialists’ job situation within this new context. Methods Qualitative data were collected through field notes and five focus group interviews. The study participants were 36 IPS employment specialists located at 13 different sites in Northern Norway. Transcripts and field notes were analysed by thematic analyses. Results Our findings show that the IPS structures are settled in Norway, but some challenges remain. The most prominent consequence of the new context is the challenge of integration within health teams. Nonetheless, employment specialists find their work with clients meaningful and having great impact with opportunities for personal and professional development. Conclusion IPS is anchored in Norwegian policy and several of the early intervention challenges are resolved. Our study provides increased understanding of the employment specialists job situation within the new IPS context in Norway. Employment specialists are “front-line-workers” in enacting the IPS principles, and their perspectives on the contextual change are crucial in the development of IPS.

AIMS:Both substance use and mental illness commonly onset during adolescence or young adulthood, and rates of substance use in young people with mental illness are disproportionately high. This baseline data paper from a clinical trial testing an integrated early intervention for substance use and mental health problems aims to (1) describe the characteristics of participants enrolled and (2) compare young people with a current and without a lifetime diagnosis of substance use disorder (SUD) in terms of psychiatric symptoms, functioning, and substance use. METHODS:Seventy-nine participants aged 12-25 years with high prevalence mental illness (e.g., depression, anxiety) and substance use seeking mental healthcare were recruited from headspace primary mental health centres in North-Western Melbourne. At baseline, they completed self-report and interview measures of psychiatric diagnoses and symptoms, functioning, and substance use. We compared those with a current (n = 51) and without a lifetime (n = 21) SUD on these measures. This is a secondary data analysis of baseline data for the INTEGRATE clinical trial. RESULTS:Youth with an SUD endorsed more severe depressive and anxiety symptoms, and lower quality of life and role functioning than those who used substances without a lifetime SUD. They also had more alcohol-related problems and higher frequency cannabis use and higher risk scores for alcohol, tobacco, cannabis, cocaine, amphetamine-type stimulants and hallucinogen use. There were no group differences in social and occupational functioning or subjectively rated sleep quality. CONCLUSIONS:Findings highlight the need for early identification and integrated care models within youth mental health services to address the high prevalence and impact of substance use, potentially reducing adverse effects of co-occurring SUD and mental illness on youth development and functioning. TRIAL REGISTRATION:The study was preregistered (ACTRN12619001522101).

Background: Adolescence is a critical developmental phase during which young people are vulnerable to the experiences of mental ill-health and social exclusion (consisting of various domains including education and employment, housing, finances and social supports and relationships). The aims of this study were to: (i) obtain an understanding of the relationships between social exclusion, mental health and wellbeing of young people; and (ii) identify potentially modifiable targets, or population groups that require greater or targeted supports.Methods: Data was obtained from the Mission Australia 2022 Youth Survey, Australia’s largest annual population-wide survey of young people aged 15-19 years (n=18,800). Participants’ experiences of social exclusion in different domains were explored (e.g., prevalence, co-occurrence, and controlling for differences in demographic characteristics). Multivariable linear regression models were used to map the relationships between social exclusion domains and mental health and wellbeing, controlling for confounding factors where necessary.Results: 60% of all young people experienced social exclusion in at least one domain, 25% in multiple. Young people who identified as gender diverse, Indigenous, living in a remote/rural or socioeconomically disadvantaged area, and with a culturally diverse background were more likely to report social exclusion. A strong association was seen between all domains of social exclusion and poor mental health (e.g., higher psychological distress and loneliness, reduced personal wellbeing, reduced sense of control over their life, and a more negative outlook on the future). Notably, difficulties in socialising and obtaining social support were critical factors linked to increased psychological distress and reduced wellbeing. Conclusions: Findings underscore the need to address multiple domains of social exclusion concurrently, and in collaboration with youth mental health care. Prevention efforts aimed at early identification and intervention should be prioritised to support young people vulnerable to social exclusion. Screening approaches are needed to identify individuals and groups of young people in need of support, and to facilitate care coordination across multiple providers.

First Episode Rapid Early Intervention for Eating Disorders (FREED) is an early intervention service model and care pathway for young people aged 16–25 with a recent-onset eating disorder. This multi-site study aimed to evaluate the feasibility of a newly developed implementation fidelity tool and observe patterns of fidelity to FREED. Six eating disorder services across England took part in an assessment. Data were collected from 242 patient referrals between January and June 2025 and via semi-structured interviews with FREED staff. Total fidelity scores were calculated alongside two component scores (rapid access to the service and early intervention care package), and inter-rater agreement was assessed. The tool was feasible to use across multiple services, time efficient, aligned with existing workflows, and demonstrated high inter-rater agreement. The average fidelity score across services was 72% (‘medium fidelity’). The average component scores were 57% for rapid access targets (‘not satisfactory’) and 77% for early intervention care package (‘medium fidelity’). Rapid access target scores were highly variable across services (20–87%), whereas care package scores were more consistent (72–82%). Additional sustained resource augmentation is needed to improve model adherence and facilitate consistent access to high-quality early intervention for eating disorders, including support to meet rapid access targets.

INTRODUCTION:People with psychotic disorders face a significant disparity in life expectancy, primarily due to preventable health conditions. Mental health clinicians play a vital role in addressing these issues, yet barriers such as a lack of training, low confidence, and unclear role responsibilities impede effective interventions. This study explores the motivation, perceived competence, and communication styles of clinicians addressing physical health for young people with first-episode psychosis, using Self-Determination Theory as a framework. METHODS:A mixed-methods design was employed, involving semi-structured interviews with six case managers and five psychiatrists at a specialised early intervention service. Thematic analysis identified key themes, and quantitative ratings assessed attitudes, perceived competence, and communication styles. Results were synthesised into Self-Determination Theory constructs. RESULTS:Quantitative ratings highlighted gaps in training, resources and prioritisation of physical health. Seven themes emerged from clinician interviews: (1) role responsibility, (2) constrained autonomy, (3) autonomous motivation, (4) clinician competence, (5) perceived young person's competence, (6) domain-dependent communication and (7) the centrality of relatedness for treatment. Clinicians reported a more directive approach for weight-related issues compared to substance use. CONCLUSION:Clinicians face significant systemic and individual barriers to addressing physical health in first-episode psychosis. Enhancing autonomy-supportive environments, clarifying role responsibilities and providing targeted training could improve engagement and outcomes. Integrating physical health within mental healthcare must be prioritised to reduce disparities.

ObjectivesIndividual placement and support (IPS) is an evidence-based form of vocational rehabilitation that aims to help people with mental illness obtain and remain in competitive employment. The objective of this study is to quantify the national growth of IPS over an 8-year period in Norway.MethodsUsing a combination of qualitative and registry data, we map how IPS was implemented in Norway between 2012 and 2019, both in terms of geographic availability and intensity of service provision.ResultsIn 2012 IPS was available in 4 out of 19 counties, with 14.9% of the population living in an area where IPS was present. By 2019 this had increased to all 19 counties in Norway, and more than 70% of the population lived in an area of Norway where IPS was available. The results are presented in eight heat maps that visually display how the intensity and availability of the service have expanded.ConclusionThis study has identified when and where IPS became available in Norway, which is key to future effectiveness studies of IPS in the IPSRON project.

AIMS:There is growing awareness of the negative impact that extreme weather events (also known as climate disasters) have on psychological and social wellbeing. Adolescents are particularly vulnerable to the psychosocial impacts of these events, but research specific to this population is scant. This study examined the impact of exposure to extreme weather events on climate concerns, psychological distress, and social exclusion in a large nationwide sample of adolescents. METHOD:Data on exposure to extreme weather events, climate concerns, psychological distress, and indicators of social exclusion were obtained from the 2023 Mission Australia Youth Survey-Australia's largest cross-sectional survey of adolescents aged 15 to 19 (N = 19,501). Multivariable multinomial and logistic regression analyses were used to identify participant-specific characteristics that were associated with exposure to extreme weather events and examine the association between event exposure and psychological distress/social exclusion. RESULTS:Adolescents living outside major cities, in lower socioeconomic areas, who identify as trans or gender diverse, living with disability, culturally or linguistically diverse (CALD) and/or Indigenous, were more likely to encounter extreme weather events. Compared to adolescents who were not exposed to extreme weather events, those who were exposed were at greater risk of experiencing climate concerns, psychological distress, financial hardships, and housing challenges. Adolescents whose households were impacted experienced greater financial hardship and housing challenges than those whose communities (but not households) were impacted. CONCLUSIONS:Adolescents impacted by extreme weather events experience an increased risk of psychological distress, housing challenges and financial difficulties. Post-event recovery/resilience strategies need to prioritise mental health, housing, and financial support services, with a particular emphasis on supporting adolescents from historically disadvantaged or marginalised backgrounds.

AIMS:Education is a key goal of young people experiencing mental ill-health and is crucial for many aspects of enjoyable, meaningful lives. However, the completion of education can be a challenge. This paper evaluated the expanded implementation of a targeted education support programme for young people with mental ill-health. METHODS:A retrospective chart audit of the 125 young people accessing a range of mental health services in a metropolitan region referred to the intervention between January 2022 and June 2023 was conducted. Education, demographic and administrative data were collected. The primary outcome was engagement in education (both secondary and higher), measured as both maintaining education and engaging in new educational opportunities. Fifteen clinicians were also surveyed on their perspectives on the intervention. RESULTS:One-hundred and twenty-two referrals were accepted, 93 young people engaged and 70 were supported to engage with education. Half of the young people who were not engaged in education prior to participating were successfully supported to re-engage. However, the intervention was less integrated between referring services than during a previous pilot phase. Clinicians viewed the intervention as contributing to the development of generalisable skills and enhancing efficacy of care, but viewed a lack of co-location at every site as a substantial barrier to integration. CONCLUSIONS:In a large sample embedded in a real-world setting, the current paper demonstrates positive outcomes of supported education within youth mental healthcare. Further studies are needed to demonstrate efficacy with control groups and to explore the perspectives of young people and carers.