Rethinking how we deliver mental health care

Enhanced access to specialised care leads to better outcomes, but its realisation in practice requires us to challenge traditional notions of how mental health care is delivered.

The fundamental approach for how we deliver mental health care has remained largely unchanged for decades. Mental health care has long followed a three-tiered system—primary, specialised, and tertiary care—designed to manage limited resources and match care intensity to illness severity. Typically primary care serves as the first point of contact, specialised care handles more complex conditions, and tertiary care addresses the most acute and severe cases.

But this system emerged in a world that is very different to the one we live in today. The internet and digital technologies have vastly changed this landscape, and provide the opportunity for a radically different approach.

A recent study by our team challenges the status quo about how best to allocate our resources to deliver mental health care to young people. Its findings are both intriguing and instructive, challenging accepted assumptions while paving the way for more efficient, equitable, and effective approaches to youth mental health care.

Photo by Drew Beamer on Unsplash

Why early intervention and specialised care matter

There is widespread agreement that mental health issues in young people are a major public health priority. Mental disorders are the leading cause of disability in adolescents and young adults worldwide, meaning interventions must be both timely and effective.

It is worth dwelling on what is meant by timely and effective. Timely, refers to intervening early enough to prevent or delay progression toward more severe illness. This often means ensuring that support reaches individuals before they experience entrenched symptoms or functional decline. Effectiveness speaks to interventions that clearly improve outcomes—whether by restoring daily function, reducing symptom burden, or hopefully both.

To cope with limited specialised resources, stepped care models encourage clinicians to reserve specialised services for those with more severe illness, funnelling milder cases through primary care first. While this seems logical, complex health systems do not always behave as expected.

A critical assumption underlying this approach is that the early stages of serious mental illness can be readily identified and responded to. Yet, reliable metrics or diagnostic tests for mental health conditions do not exist. Unlike many physical health conditions, psychological distress and risk factors are often subtle, overlapping, and influenced by personal and environmental contexts. This is particularly true for young people who tend to present with sub-threshold and mixed symptoms in the context of novel and transient social and environmental circumstances.

While still not perfect, specialised practitioners—who typically have more extensive training, experience, and deeper clinical knowledge—tend to be more effective at identifying people at risk and responding with effective interventions. This is why our modelling shows that delaying access to specialised treatment, even for milder presentations, can lead to worsening symptoms and higher rates of disengagement—an unintended consequence that underscores how 'common-sense' solutions can sometimes backfire in complex systems.

Generating insights for a more effective mental health system

Dynamic modelling simulates how various parts of a complex system—consumers, care providers, waiting times, illness progression, risk of dropping out—interact over time. These models allow us to explore different “what if” scenarios.

By adjusting variables such as the proportion of spending devoted to specialised care, or the referral pathways, the model can highlight which configurations lead to the fewest young people progressing to more severe stages of illness or dropping out of treatment altogether.

Some critical findings from this work and their implications for policy and practice are:

1. Direct access to specialised care is paramount for early intervention

Limiting specialised care only to more severe cases or those who fail primary care risks delaying potentially more effective interventions. Early access to specialised care was linked to a decrease in overall progression to more severe illness and fewer people disengaging from services. Mild problems often respond faster to effective treatment so preventing escalation not only spares individuals from unnecessary distress but also reduces the pressure on the mental health system. Over time this improves the systems overall capability to respond effectively.

Importantly, access to specialised care does not mean providing medical interventions to everyone, but rather access to the specialised expertise and knowledge required to recommend the appropriate type and sequence of interventions and monitoring plan for a person.

2. Expanding specialised care capacity

Boosting the share of the total budget allocated to specialised care improves aggregate outcomes, as long as direct referral to specialised care is an option. Even though specialised services are more costly per person than primary care, the investment pays off. Training more psychiatrists, clinical psychologists, and other mental health professionals is rarely achieved overnight. Yet the modelling results imply that every step towards expanding the specialised workforce can create ripple effects throughout the system.

3. Leveraging the complementary role of digital technologies

Expanding specialised care capacity also has a new meaning in the digital age. Artificial intelligence (AI) and other digital tools are rapidly changing how we collect, analyse and provide care. Enhancing specialised capacity also means leveraging new technologies to enhance the primary care workforce with specialist capabilities and using AI systems capable of specialised decision making.

Online self-directed care can also fill another important gap. With digital mental health, the notion of a wait list is outdated. People can engage with evidence-based interventions immediately (digital CBT, find a practioner online, etc), which helps reduce wait times and prevents the more serious deterioration seen when treatment is delayed.

A forward-looking perspective

This particular study underscores the importance of thinking beyond the typical pathways into care and beyond the notion that more complex (and often more expensive) specialised care should be a final resort.

Investing in more specialised mental health services for youth—and leveraging new technologies to do so—can reduce both the number of individuals progressing to more severe conditions and the number of young people disengaging from care altogether. This isn’t just about the workforce (though that is important), it is about the digital infrastructure required to increase, connect and coordinate specialised care across the system.

For families, and young people themselves, the message is encouraging and clear: by eliminating some of the unnecessary hurdles that keep young people from the help they need, we can reshape our system to produce better results overall. In a field where every delay can have a profound effect, these findings are a call for more innovative, proactive approaches which rethink how we deliver mental health care and challenge existing notions.

This work shows that earlier, more direct access to specialised mental health services is not merely a nice ideal but potentially the most efficient and effective option. While barriers—funding, workforce availability, entrenched models of care—remain, the study’s key lesson is that timely investment in stronger specialised service capacity and digital health solutions pays dividends at a system level.

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