Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

Open Forum   |    
A Clinical Staging Model for Early Intervention Youth Mental Health Services
Shane P. M. Cross, B.Psych., M.Psych.(Clin.); Daniel F. Hermens, Ph.D.; Elizabeth M. Scott, B.Sc., M.B.B.S.; Antonia Ottavio, Dip.Hth.Sc., B.Nursing; Patrick D. McGorry, M.D., Ph.D.; Ian B. Hickie, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300221
View Author and Article Information

Except for Prof. McGorry, the authors are with the Brain and Mind Research Institute, University of Sydney, New South Wales, Australia (e-mail: shane.cross@sydney.edu.au). Prof. McGorry is with the Centre for Young People's Mental Health, Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.

Copyright © 2014 by the American Psychiatric Association


Transformational reforms in mental health services are providing more young Australians who experience mental health problems with access to high-quality care. However, the current diagnostic approach has low utility in the early stages of illness, causing uncertainty among clinicians in regard to matching clients’ needs with safe and effective interventions. The authors propose a clinical staging model that has the potential to better match illness stage to intervention. The model allows clinicians to provide more personalized and responsive care, especially to young people with attenuated syndromes (subthreshold disorders) who have a clear need for mental health care but who may not otherwise receive it. This approach can also assist clinicians in considering the potential trajectory of illness. Recent research using this framework has demonstrated the model’s prospective utility. The authors describe application of the model in an early intervention youth mental health service in Australia.

Abstract Teaser
Figures in this Article

Your Session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).



Merikangas  KR;  Nakamura  EF;  Kessler  RC:  Epidemiology of mental disorders in children and adolescents.  Dialogues in Clinical Neuroscience 11:7–20, 2009
McGorry  P:  Prevention, innovation and implementation science in mental health: the next wave of reform.  British Journal of Psychiatry Supplement 54:s3–s4, 2013
[CrossRef] | [PubMed]
Patel  V;  Flisher  AJ;  Hetrick  S  et al:  Mental health of young people: a global public-health challenge.  Lancet 369:1302–1313, 2007
[CrossRef] | [PubMed]
Hickie  IB:  Youth mental health: we know where we are and we can now say where we need to go next.  Early Intervention in Psychiatry 5(suppl 1):63–69, 2011
[CrossRef] | [PubMed]
McGorry  PD:  The specialist youth mental health model: strengthening the weakest link in the public mental health system.  Medical Journal of Australia 187(suppl 7):S53–S56, 2007
McGorry  PD;  Tanti  C;  Stokes  R  et al:  headspace: Australia’s National Youth Mental Health Foundation—where young minds come first.  Medical Journal of Australia 187(suppl 7):S68–S70, 2007
McGorry  PD;  Bates  T;  Birchwood  M:  Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK.  British Journal of Psychiatry Supplement 54:s30–s35, 2013
[CrossRef] | [PubMed]
McFarlane  WR;  Cook  WL;  Downing  D  et al:  Portland identification and early referral: a community-based system for identifying and treating youths at high risk of psychosis.  Psychiatric Services 61:512–515, 2010
[CrossRef] | [PubMed]
Lewinsohn  PM;  Shankman  SA;  Gau  JM  et al:  The prevalence and co-morbidity of subthreshold psychiatric conditions.  Psychological Medicine 34:613–622, 2004
[CrossRef] | [PubMed]
Patton  GC;  Hetrick  SE;  McGorry  P:  Service responses for youth onset mental disorders.  Current Opinion in Psychiatry 20:319–324, 2007
[CrossRef] | [PubMed]
APA:  Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Text Revision .  Washington, DC,  American Psychiatric Association, 2000
Hickie  IB;  Scott  J;  Hermens  DF  et al:  Clinical classification in mental health at the cross-roads: which direction next? BMC Medicine 11:125, 2013
[CrossRef] | [PubMed]
Hickie  IB;  Scott  EM;  Hermens  DF  et al:  Applying clinical staging to young people who present for mental health care.  Early Intervention in Psychiatry 7:31–43, 2013
[CrossRef] | [PubMed]
McGorry  PD:  Risk syndromes, clinical staging and DSM V: new diagnostic infrastructure for early intervention in psychiatry.  Schizophrenia Research 120:49–53, 2010
[CrossRef] | [PubMed]
McGorry  P;  van Os  J:  Redeeming diagnosis in psychiatry: timing versus specificity.  Lancet 381:343–345, 2013
[CrossRef] | [PubMed]
Hamilton  BA;  Naismith  SL;  Scott  EM  et al:  Disability is already pronounced in young people with early stages of affective disorders: data from an early intervention service.  Journal of Affective Disorders 131:84–91, 2011
[CrossRef] | [PubMed]
Scott  E;  Naismith  S;  Whitwell  B  et al:  Delivering youth-specific mental health services: the advantages of a collaborative, multi-disciplinary system.  Australasian Psychiatry 17:189–194, 2009
[CrossRef] | [PubMed]
Fergusson  DM;  Horwood  LJ;  Ridder  EM  et al:  Subthreshold depression in adolescence and mental health outcomes in adulthood.  Archives of General Psychiatry 62:66–72, 2005
[CrossRef] | [PubMed]
Axelson  DA;  Birmaher  B;  Strober  MA  et al:  Course of subthreshold bipolar disorder in youth: diagnostic progression from bipolar disorder not otherwise specified.  Journal of the American Academy of Child and Adolescent Psychiatry 50:1001–1016, 2011
[CrossRef] | [PubMed]
Yung  AR;  Stanford  C;  Cosgrave  E  et al:  Testing the Ultra High Risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people.  Schizophrenia Research 84:57–66, 2006
[CrossRef] | [PubMed]
McGorry  PD;  Hickie  IB;  Yung  AR  et al:  Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions.  Australian and New Zealand Journal of Psychiatry 40:616–622, 2006
[CrossRef] | [PubMed]
Cosci  F;  Fava  GA:  Staging of mental disorders: systematic review.  Psychotherapy and Psychosomatics 82:20–34, 2013
[CrossRef] | [PubMed]
Scott  EM;  Hermens  DF;  Glozier  N  et al:  Targeted primary care-based mental health services for young Australians.  Medical Journal of Australia 196:136–140, 2012
[CrossRef] | [PubMed]
Catania  LS;  Hetrick  SE;  Newman  LK  et al:  Prevention and early intervention for mental health problems in 0–25 year olds: are there evidence-based models of care? Administration in Mental Health 10:6–19, 2011
Hermens  DF;  Naismith  S;  Lagopoulos  J  et al:  Neuropsychological profile according to the clinical stage of young persons presenting for mental health care.  BMC Psychology 1:1–8, 2013
Lin  A;  Reniers  RL;  Wood  SJ:  Clinical staging in severe mental disorder: evidence from neurocognition and neuroimaging.  British Journal of Psychiatry Supplement 54:s11–s17, 2013
[CrossRef] | [PubMed]
Schwalbe  C;  Gearing  R:  The moderating effect of adherence-promoting interventions with clients on evidence-based practices for children and adolescents with mental health problems.  American Journal of Orthopsychiatry 82:146–155, 2012
[CrossRef] | [PubMed]
Lagopoulos  J;  Hermens  DF;  Naismith  SL  et al:  Frontal lobe changes occur early in the course of affective disorders in young people.  BMC Psychiatry 12:4, 2012
[CrossRef] | [PubMed]
References Container

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe

Related Content
Textbook of Psychotherapeutic Treatments > Chapter 18.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 63.  >
Textbook of Traumatic Brain Injury, 2nd Edition > Chapter 32.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 30.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 30.  >
Topic Collections
Psychiatric News
PubMed Articles