Mental illness emerges in young people. The major adult mental illnesses begin from puberty through to the mid-20s, and that's the peak period of onset across the whole lifespan for illnesses like schizophrenia, bipolar disorder, borderline personality, anorexia nervosa, and so on. There are some childhood illnesses like ADHD and autism spectrum, but most of the adult type mental illness appears in this transition period from puberty through to the mid-20s. Yet our mental health services have traditionally not been focused on that age group at all. They've been focused either on younger children or more typically, middle-aged people with more long-term and persistent chronic mental illnesses. That's how they were designed, and that was before effective treatments were really available, so there wasn't much logic or momentum behind the early diagnosis and trying to change the course of these illnesses.  So there wasn't much interest really in adolescents or young adults. The mental health services were like safety nets to look after people in the chronic phase of illness.

Now, 30 odd years ago, deinstitutionalization occurred and we moved into mainstream health care with psychiatry, but the thinking didn't really change. It was difficult to change the thinking and promote early intervention, which obviously meant to focus on young people. And we had the situation then where the greatest need for mental health care was in this age group, especially with a view to preventing long-term illness and chronicity, but there was very little investment or interest in it or expertise. And that's been changed steadily over the last 30 years as we've built a field of both early intervention, on the one hand, starting with psychotic illnesses and now spreading across the diagnostic spectrum, but also with systems of care that are co-designed with young people to be youth-friendly and to be much better resource to manage this transition period. The developmental challenges that impact adolescents and emerging adults are very different from younger children and older people too. So there is a need for that sort of expertise and that mindset, and also the involving the scaffolding, the family and friends and peer groups in the care. So you need whole new systems of care. And we've had some success in building those in recent years, but it's still really at base camp. Most of those reforms have been in primary care-based services, like Headspace in Australia or integrated youth services in Canada, for example, or Jigsaw in Ireland. But it's only 15 countries that have really done much work in that space, and it's still early days. The mainstream mental health system is still organized around a pediatric adult model, which really doesn't do a very good job with these young people in transition in the early stages of illness. The child and adolescent system is very focused on younger children and has a lot of trouble coping with the emerging more serious mental illnesses of adult type. The adult system is still very weighted towards people with long-term illnesses who need longer-term care, even though that is very poorly resourced and supported by governments around the world as well. Psychiatry, in general, is neglected by government and by society. And we're missing big opportunities to actually turn that around by having a strong focus on early intervention young people, and then backing that up with longer-term care for those who need it in an equitable and compassionate way. We have a long way to go. But we have the knowledge and we have the systems to do it if the political will is there. And if the profession is able to free itself up from more traditional thinking as well.

精神疾病往往在青少年时期出现。从青春期到20多岁，是精神分裂症、双相情感障碍、边缘型人格障碍、厌食症等众多成年精神疾病的高发期。虽说像多动症、自闭症谱系障碍这类疾病在儿童时期就会出现，但大部分成年精神疾病还是集中在青春期到20多岁的阶段。然而，精神健康服务向来不怎么关注这个年龄段的群体，要么偏向年幼儿童，要么倾向于患有长期慢性精神疾病的中年人。这其实是因为在有效的治疗手段出现之前，早期诊断和改变疾病发展走向的思路并没有太多依据，所以大家对青少年和年轻人的精神健康关注较少，相关服务就像“安全网”，主要服务于慢性病患者。

大约30年前，去机构化现象出现，精神科治疗逐渐融入主流医疗体系，但人们的思维模式并未随之改变，要转变思维、推动早期干预，把关注重点放在年轻人身上并非易事。彼时，这个年龄段的人群对精神健康护理的需求最为迫切，预防长期疾病和慢性病尤为重要，但当时相关投入、专业人才都极为匮乏。好在最近 30年情况有所改观，早期干预领域逐渐兴起，从精神疾病起步，如今已覆盖更广泛诊断范围；同时，与年轻人共同设计的友好型护理系统也应运而生，能更好地助力他们度过过渡时期。

青少年及成年初期人群面临的成长挑战与年幼儿童、老年人有很大不同，所以急需专业人才和专业思维，还需引入家庭、朋友、同龄人等支持力量。全新的服务体系亟待建立，好在近年来已小有成效，像澳大利亚的Headspace项目、加拿大的综合青少年服务项目、爱尔兰的Jigsaw项目等初级保健服务模式都在积极探索。不过，目前全球仅有15个国家在这方面有所行动，整体仍处于起步阶段。主流心理服务体系依旧围绕儿童-成人模式展开，对处于疾病早期的年轻群体适配性较差。

儿童青少年精神健康服务体系主要聚焦低龄儿童，面对日益严重的成人类型精神疾病时，应对起来捉襟见肘；而成人服务体系则过于侧重长期患病、需长期护理的群体，此类服务在全球范围内资源匮乏，政府支持力度也远远不够。总的来说，精神病学领域在政府和社会层面都备受忽视。如果我们把重点放在年轻人的早期干预上，并以公平、富有同情心的方式为有需要的人提供长期护理，我们就能抓住很多扭转局面的机会。只是，目前我们仍有很长的路要走，好在知识和体系已然具备，若能有政治意愿推动，专业领域也能突破传统思维桎梏，未来大有可为。

That is a great question. And it's a very simple answer. We need to create a new subspecialty of youth psychiatry. And we are in the process of doing that here in Australia. We have an advanced training program for psychiatrists that want to specialize in this stage of life, this transition period between childhood and adulthood. Traditional child and adolescent training is insufficient for that, as it cuts out in the late teens and doesn't embrace the early adult period. We know that young people these days take longer to grow up and become mature adults than they did 30 or 40 years ago. There are developmental aspects as well as early intervention and other skill bases that are needed to properly look after these patients. And also, we need to work with the young people themselves and co-design and operate these new cultures of care.

However, the profession is typically very conservative. It has had enough trouble sustaining itself with the current paradigm. It's not a strong profession within medicine and is low on the pecking order, so it's struggled a bit. And in the current period of history, probably even more challenges are facing psychiatry.

But this is one way we can actually get ahead of the game and show how effective our work can be by developing a strong model of care, powered by research and with great leadership from people trained and specialized in this youth mental health area. It's a very rewarding area to work in. You see tremendous results and much better outcomes, and it's an absolute delight to work with young people.

So we have to build these training systems to support it, not just in psychiatry but also in other allied health professions like psychology and all the other allied health professions, as well as nursing. We need to develop a culture of care with the right workforce, which also involves peer workers, other young people, and families. It's very exciting and a great opportunity for psychiatry. The question is, how conservative will the profession be? Will it resist it, support it, or just sit by with inertia and allow a subset of leaders to drive it? We need the institutional support of the profession to make this work.

我们急需开创青少年精神病学这一分支学科，目前在澳大利亚我们正致力于此。我们设立了高级培训项目，旨在为有志于专注儿童到成年过渡阶段的精神科医生提供专业进阶培训。传统儿童青少年精神医学培训存在局限，青少年后期就截止了，并未涵盖成年早期阶段。如今，年轻人成长为成熟成年人所需要的时间，要比30或40年前更长。要妥善照顾这个阶段的患者，需要兼具发展学知识、早期干预手段以及其他专业技能。

而且，我们还应和年轻人携手，共同设计和运营这些全新的护理文化。但精神医学领域向来较为保守，在当前医学格局下，其自身发展都面临不少困难，处于医学领域相对弱势的位置。不过，这正是我们抢占先机的好机会，凭借以研究为支撑的强大护理模式，再加上经过专业培训、专注于青少年精神健康的领军人物的引领，定能彰显该领域的巨大潜力。

在这个充满机遇的赛道上，投身其中定会收获满满，我们能够见证显著的疗效和更好的愈后表现。所以，我们必须构建相应的培训体系，涵盖精神医学，也囊括心理学、其他相关健康专业以及护理学等领域。我们需要培育一种关爱文化，汇聚专业人员、同伴支持者、年轻人自身以及家庭力量。精神病学正站在一个关键岔路口，是故步自封、被动观望，还是开放接纳、积极支持新兴变革？这取决于整个专业能否摒弃保守心态，给予有力的体系支撑。

I think the most important questions in research are fairly fundamental ones. We still don't have a good enough understanding of the mechanisms underpinning the onset of these emerging, potentially serious mental illnesses. We understand a fair bit about the psychological, social, and even economic risk factors that contribute to these illnesses, but the fundamental mechanisms, not just biological ones, are still unclear. What are the mechanisms that could be targets for treatment? That's the holy grail in mental health research, and funding bodies have tried to focus on this. But I think we need to go one step further.

Our diagnostic system is essentially descriptive. There are many disorders in this age group for which we don't have a fundamental understanding. For example, while we have a better understanding of psychotic illnesses like psychosis and bipolar disorder, when it comes to illnesses like anorexia nervosa, especially in the early stages, I don't think there's a good understanding of the nature of that illness. What kind of illness is it? What allows it to develop in a particular way? What are the underlying mechanisms?

There's a lot of pop psychology and mythology surrounding anorexia, confusing peripheral issues like fashion magazines and body image in the wider environment as risk factors. They may be risk factors, but they're not strong explanations. They don't get to the heart of the nature of the illness or the mechanisms that would allow us to treat these patients more effectively. There haven't been any real advances in that area for 30 or 40 years. This criticism probably also applies to other areas like schizophrenia and psychosis.

We still haven't invested enough in novel treatments. It's extremely hard to get funding for new treatments or repurposing existing ones. This contrasts sharply with fields like cancer and other areas of medicine where there's tremendous growth in novel therapies and new mechanisms. Psychiatry hasn't kept pace with these dynamic fields. It's not the fault of the researchers but rather the funding agencies and governments that haven't made it a priority. However, we definitely need massive investment in novel treatments.

当下精神健康研究领域最为核心的问题，归根到底是那些基础性课题。对于这些新发且可能演化为严重精神疾病的发病机制，我们尚未洞悉其全貌。虽说对于引发这些疾病的心理、社会以及经济风险因素，我们已有一定了解，但对于关键的致病机理，绝非仅靠生物学层面的探索就能触及。这些潜在的治疗靶点，恰是精神健康研究的目标，众多资助机构也极力推动相关探索。

但问题不止于此，我们的诊断体系本质上仍是描述性的。在这一年龄段，诸多精神疾病初露端倪，可我们对其背后的根本原理知之甚少。论及精神病、双相情感障碍这类疾病，我们或许已有较为清晰的认知，甚至对焦虑症也有所涉猎，但对于神经性厌食症这类疾病，尤其在疾病早期，我们仍处于认知的迷雾之中。它究竟是怎样一种疾病？何种因素促使其以独特的方式发展？其内在的病理机制又是什么？目前这些关键问题仍未有明确答案。

在大众认知里，流行心理学和种种神话传说混淆视听，把时尚杂志、社会环境中的身体形象等边缘因素当作厌食症的罪魁祸首。虽说这些因素可能确实在一定程度上增加了患病风险，但它们绝非问题的根源所在，也无法为我们深入理解疾病的本质、探索更有效的治疗方法提供有力支撑。令人遗憾的是，这一领域在过去三四十年间几乎毫无进展，精神分裂症、精神病等其他疾病的研究也面临着类似困境。

更令人担忧的是，我们在新型治疗手段的研发上投入严重不足，资金短缺已成为常态。这与癌症等其他医学领域的蓬勃发展形成鲜明对比，在那些领域，新型疗法和治疗机制层出不穷，展现出蓬勃的创新活力。精神医学领域的滞后并非研究者的责任，而是资助机构、政府部门以及整个社会未将其作为优先发展事项的后果。但现在是时候奋起直追了，新型治疗方法的研发亟待大规模资金注入。