The dual continua in mental health policy and practice: Screening and intervention for low mental wellbeing in youth to achieve targeted prevention

Background: The mental health of young people in Australia and other nations has declined dramatically over the last decade and a half. While an increase in youth mental healthcare services is needed to meet rising demand, on its own, this is unlikely to reverse the concerning trend. A greater focus on prevention is needed.Aims: This article aims to propose an innovative, theoretically-grounded approach to prevention that complements more common population-based (i.e., changing risk and protective factors) and targeted (i.e., supporting individuals with subthreshold symptoms of mental illness) approaches. Aligned with the dual-continua model of mental health (i.e., where mental well-being and ill-health are distinct dimensions of overall mental health), this third approach focuses on addressing low levels of mental wellbeing, which is both a significant predictor of future mental ill-health and a distressing and disabling state that requires intervention in its own right. Recommendations: Large-scale screening for low mental wellbeing, using psychometrically sound tools, could be conducted online and through schools, higher education, and primary care services. Those with low mental wellbeing could be linked to community services offering evidence-based interventions. This approach is likely to carry less stigma and may be easier to achieve than targeting those with subthreshold symptoms through clinical services.Conclusions: The dire state of youth mental health is an urgent call-to-action to adopt novel approaches to address this crisis. We need to make better use of the available evidence and tools at-hand to strengthen our focus on low mental wellbeing, not just mental ill-health.