Some recent work reported online on 3rd January 2025 in the Australian and New Zealand Journal of Psychiatry revealed that in 2021 one in three young Australians 20 years and under had been prescribed a mental health drug. Of those prescriptions almost one in four (24.1%) had been for antidepressants, 10% for stimulants, 4.3% for antipsychotics, 3.8% for anxiolytics and 1.4% for hypnotics or sedatives.
These prescribing rates are concerning, given that we have all been aware for a long time of the potential for harm these drugs have for developing brains.
They are also surprising, especially when compared with the much lower prescribing rates in young people elsewhere in the world. Whilst the rate of mental illness is steadily increasing in young people there is no reason to suspect that mental health problems in young people are any more prevalent in Australia than elsewhere in the developed world where significantly less prescribing for young people occurs.
Why we are so reliant on pharmaceutical interventions in young people in Australia?
Accessibility and affordability of specialised care
The problem of accessibility to specialised mental health care (in the form of allied mental health specialists as well as psychiatrists) is not just confined to rural Australia and is compounded by the cost of such services. Medicare rebates have helped, but not enough. There are many places where it is not possible to access specialised services without paying a considerable gap fee. Telehealth has helped, but not enough. Very few telehealth providers offer affordable services.
Inadequacy of General Practice care
It is a truth universally acknowledged (with apologies to Jane Austen), that GPs are overworked, underpaid and for the most part inadequately trained or unconfident (or both) in mental health care delivery. They are however the first port of call for young people in need of mental health support.
You can imagine that it is very tempting for an overwrought GP faced with a young person in distress and a long waiting list for any kind of specialised care (not to mention patient reluctance to go down that path) to turn to medications for help. This is not always a bad thing but there are many situations in which psychological support is the preferred first line treatment and GPs on the whole do not feel confident enough to deliver therapy.
What are the solutions?
Here’s a list of possibilities (bear with me – I’m brainstorming in true structured problem-solving style so there will be “issues” with all these solutions and I’m thinking big):
- Increase the Medicare rebate for mental health services (specialist, GP and telehealth services) and make charging a gap fee illegal
- Train more mental health specialists and require them to work in rural and remote areas
- Increase the requirement for GP mental health training (or, better still, take steps to increase the mental health knowledge of all medical practitioners by improving mental health knowledge before they graduate)
- Expand youth community health centre services
- Reduce the stigma associated with poor mental health
- Increase efforts to prevent mental health problems in young people
- Address social determinants of poor mental health
I know what you’re thinking!
Many people all over Australia are working on parts of these solutions. Many of the solutions (or parts of them) would be unacceptable to either governments or practitioners or both. Even if acceptable, many of the solutions would take years to have any impact at all (eg those involving training).
What we need is something that will help young people who are struggling right now!
Where dMH fits in
Using dMH resources may not be a long term or ideal solution to the problem of overprescribing to young people but it could contribute to the solution. People (and I’m not just talking about health professionals here) need to know that these resources exist and that they are effective. Online resources can provide early intervention, psychoeducation, basic CBT training and resilience building skills. Some can provide support in difficult times.
There are an increasing number of Australian developed evidence-based dMH programs and resources designed specifically for young people.
If all this interests you because you want to decrease your reliance on prescribing for young people or for any other reason take a look at some of my favourite dMH resources for young people:
A resilience building program for young people from Black Dog Institute.
A program from the University of Queensland to help 3-17 year olds (and their parents) manage anxiety symptoms.
A website that offers tailored programs for 7-17 year olds to help them manage sadness and worry.
An app from Black Dog Institute to help young people understand and normalise their sleep.
You can find out more about other dMH resources specifically for young people on the eMHPrac website. Here’s a link to a useful summary.
What should we do next?
Having become acquainted with and used a few of these digital resources with young people please don’t stop there. Go back to my solutions list and see if there is any small part of any solution that you can help with. Maybe a little bit more training in some aspct of mental health care might be worth considering. If so, here’s a handy link to Black Dog Institute’s professional training calendar
We all need to work very hard if we are going to help young people with their mental health in this difficult world. It won’t be as simple as writing a prescription.
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