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Capturing the Clinical Complexity in Young People Presenting to Primary Mental Health Services: a Data-driven Approach

Abstract

Aims: The specific and multifaceted service needs of young people have driven the development of youth-specific integrated primary mental healthcare models, such as the internationally pioneering services in Australia. Although these services were designed for early intervention, they often need to cater for young people with severe conditions and complex needs, creating challenges in service planning and resource allocation. There is, however, a lack of understanding and consensus on the definition of complexity in such clinical settings.

Methods: This retrospective study involved analysis of 's clinical minimum data set from young people accessing services in Australia between 1 July 2018 and 30 June 2019. Based on consultations with experts, complexity factors were mapped from a range of demographic information, symptom severity, diagnoses, illness stage, primary presenting issues and service engagement patterns. Consensus clustering was used to identify complexity subgroups based on identified factors. Multinomial logistic regression was then used to evaluate whether these complexity subgroups were associated with other risk factors.

Results: A total of 81,622 episodes of care from 76,021 young people across 113 services were analysed. Around 20% of young people clustered into a 'high complexity' group, presenting with a variety of complexity factors, including severe disorders, a trauma history and psychosocial impairments. Two moderate complexity groups were identified representing 'distress complexity' and 'psychosocial complexity' (about 20% each). Compared with the 'distress complexity' group, young people in the 'psychosocial complexity' group presented with a higher proportion of education, employment and housing issues in addition to psychological distress, and had lower levels of service engagement. The distribution of complexity profiles also varied across different services.

Conclusions: The proposed data-driven complexity model offers valuable insights for clinical planning and resource allocation. The identified groups highlight the importance of adopting a holistic and multidisciplinary approach to address the diverse factors contributing to clinical complexity. The large number of young people presenting with moderate-to-high complexity to early intervention services emphasises the need for systemic change in youth mental healthcare to ensure the availability of appropriate and timely support for all young people.

Citing Articles

Suicidality in Primary Care, Youth Mental Health Services: Prevalence, Risk Factors and Implications for Practice.

Albrecht S, Rickwood D, Telford N, Privitera G, Palfrey N Early Interv Psychiatry. 2025; 19(2):e70020.

PMID: 39932100 PMC: 11812076. DOI: 10.1111/eip.70020.


Novel youth mental health services in Australia: What differences are being reported about the clinical needs of those who attend and the outcomes achieved?.

Hickie I, Rosenberg S, Carpenter J, Crouse J, Hamilton B, Hermens D Aust N Z J Psychiatry. 2025; 59(2):99-108.

PMID: 39885731 PMC: 11783966. DOI: 10.1177/00048674241297542.

References
1.
Rickwood D, Albrecht S, Telford N . Development and Validation of a Routine Session-by-Session Experience Measure for Youth Mental Health Services: My Youth Mental Health Session Experience (MySE). Psychol Res Behav Manag. 2023; 16:4897-4908. PMC: 10710245. DOI: 10.2147/PRBM.S440083. View

2.
Andrews G, Slade T . Interpreting scores on the Kessler Psychological Distress Scale (K10). Aust N Z J Public Health. 2002; 25(6):494-7. DOI: 10.1111/j.1467-842x.2001.tb00310.x. View

3.
McGorry P, Hickie I, Yung A, Pantelis C, Jackson H . Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Aust N Z J Psychiatry. 2006; 40(8):616-22. DOI: 10.1080/j.1440-1614.2006.01860.x. View

4.
Rickwood D, Paraskakis M, Quin D, Hobbs N, Ryall V, Trethowan J . Australia's innovation in youth mental health care: The headspace centre model. Early Interv Psychiatry. 2018; 13(1):159-166. PMC: 6585724. DOI: 10.1111/eip.12740. View

5.
Hetrick S, Simmons M, Thompson A, Parker A . What are specialist mental health clinician attitudes to guideline recommendations for the treatment of depression in young people?. Aust N Z J Psychiatry. 2011; 45(11):993-1001. DOI: 10.3109/00048674.2011.619161. View