After decades of research and innovation focused on how mental illnesses can be recognised and treated early, it is time for a unified clinical staging approach to mental health to be formally adopted internationally, a major new paper has argued.
The paper, published today in the world's leading clinical psychology journal, Annual Review of Clinical Psychology, calls for an international joint committee to define and ratify a global system of clinical stages in mental ill-health, following the example of staging in cancer diagnosis and treatment, which was developed over 80 years through collaboration across 170 countries.
Lead author, Associate Professor Dominic Dwyer from Orygen and the University of Melbourne, said an international clinical staging approach was critical for addressing the youth mental health crisis, which has been worsening for decades while other medical fields have been advancing.
“When diagnosing cancer, staging plays an important role in determining the progression of a person’s illness – meaning we know how to treat them, and what to look out for,” A/Prof. Dwyer said.
“With mental ill-health, we don’t have consistent ways of describing the stages of an illness, meaning we are missing the opportunity to have shared, effective approaches to preventing illness progression and setting people on the road to recovery.”
A/Prof. Dwyer said the paper was a major step forward, summarising the last 30 years of research and clinical practice at Orygen – the world’s largest and most respected youth mental health organisation.
“We've laid out a roadmap towards more transparent and accurate diagnoses, prognoses, and treatment decisions – and with international support and consensus this has the potential to improve healthcare globally,” A/Prof. Dwyer said.
“Without a shared language to describe the stages – and potential course – of an illness, we are left with a system that is inconsistent, ineffective and potentially harmful.
“With other illnesses it is now standard practice to identify where someone is on a clinical course – for example ‘stage 3 cancer’ – as a crucial part of identifying appropriate treatment to reduce the risk of progression to more serious stages of illness.
“It should be the same with mental health – it’s more nuanced than simply saying someone ‘does’ or ‘doesn’t’ have a particular illness like depression or anorexia, there are stages and complexities we need to agree on in order to find effective ways forward.”
Orygen Executive Director, Professor Patrick McGorry, said that after Orygen's pioneering work on early intervention, internationally-recognised clinical staging was the logical next step in the mental health revolution, with the potential to turn the youth mental health crisis around.
“We've been arguing for clinical staging for decades,” Prof. McGorry said.
“With the publication in 2024 of the Orygen-led Lancet Commission on Youth Mental Health, a global consortium of experts laid out the current state of play in youth mental health, and made the economic, moral and political case for investing in better research, models of care and support for young people everywhere.
“The next step is how we address the current systemic issues and limitations, and a shared understanding of clinical staging – facilitating early intervention – is a vital part of this.
“Clinical practices that are ambiguous, conflicting, or idiosyncratic across different contexts can cause harm – and can also hold us back from making real breakthroughs in treatment and care – so we need to come together across the globe to take a consistent approach.”
More about clinical staging:
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Psychiatric, psychological, and service decisions require prediction or anticipation of clinical courses, yet there are currently no shared methods to guide these decisions.