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Rao S. The Access Paradox: unmet healthcare needs among young adults in Alberta - an exploratory study of the systemic ironies in healthcare accessibility. Int J Ment Health Nurs 2024; 33:859-868. [PMID: 38183386 DOI: 10.1111/inm.13285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
There is a pressing need to investigate how young adults' access to healthcare, including how delayed help-seeking behaviours and the complexities inherent in traditional healthcare systems, exacerbate the challenges they face. This study explores the associations among functional impairments, self-perceptions of health, anxiety and mood disorders and their potential relationship to unmet healthcare needs among young adults aged 20-29. This cross-sectional study used data from the 2017-2018 Canadian Community Health Survey to analyse a sample of 1636 young adults from Alberta, Canada. Central to the analysis was the application of conceptual framework of access to health care, as it offers a comprehensive view of healthcare access. Among the sampled young adults, 7.0% reported unmet healthcare needs. Self-perceived unmet healthcare needs were significantly associated with anxiety disorders, functional impairments-specifically cognitive and social skills, and self-perceptions of poor or fair mental health, as opposed to those perceiving their mental health as excellent. Multivariable analyses incorporating extraneous variables were not statistically significant, emphasising the critical role of systemic and structural factors in healthcare access. The study presents preliminary insights into the intricate dynamics shaping unmet healthcare needs. These insights can guide future research and practice advances, particularly in developing targeted interventions that effectively reduce healthcare disparities and enhance access to healthcare services for young adults.
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Affiliation(s)
- Sandy Rao
- Faculty of Social Work, University of Calgary, Calgary, Canada
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2
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Gao C, Cho LL, Dhillon A, Kim S, McGrail K, Law MR, Sunderji N, Barbic S. Understanding the factors related to how East and Southeast Asian immigrant youth and families access mental health and substance use services: A scoping review. PLoS One 2024; 19:e0304907. [PMID: 39008453 PMCID: PMC11249267 DOI: 10.1371/journal.pone.0304907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/20/2024] [Indexed: 07/17/2024] Open
Abstract
The objective of the review is to identify factors related to how East and Southeast Asian immigrant youth aged 12-24 and their families access mental health and substance use (MHSU) services. To address how East and Southeast Asian youth and their families access mental health and substance use services, a scoping review was conducted to identify studies in these databases: PubMed, MEDLINE (Ovid), EMBASE (Ovid), PsychINFO, CINAHL, and Sociology Collection. Qualitative content analysis was used to deductively identify themes and was guided by Bronfenbrenner's Ecological Systems Theory, the process-person-context-time (PPCT) model, and the five dimensions of care accessibility (approachability, acceptability, availability and accommodation, appropriateness, affordability). Seventy-three studies met the inclusion criteria. The dimensions of healthcare accessibility shaped the following themes: 1) Acceptability; 2) Appropriateness; 3) Approachability; 4) Availability and Accommodation. Bronfenbrenner's Ecological Systems Theory and the PPCT model informed the development of the following themes: 1) Immediate Environment/Proximal Processes (Familial Factors, Relationships with Peers; 2) Context (School-Based Services/Community Resources, Discrimination, Prevention, Virtual Care); 3) Person (Engagement in Services/Treatment/Research, Self-management); 4) Time (Immigration Status). The study suggests that there is a growing body of research (21 studies) focused on identifying acceptability factors, including Asian cultural values and the model minority stereotype impacting how East and Southeast Asian immigrant youth access MHSU services. This review also highlighted familial factors (16 studies), including family conflict, lack of MHSU literacy, reliance on family as support, and family-based interventions, as factors affecting how East and Southeast Asian immigrant youth access MHSU care. However, the study also highlighted a dearth of research examining how East and Southeast Asian youth with diverse identities access MHSU services. This review emphasizes the factors related to the access to MHSU services by East and Southeast Asian immigrant youth and families while providing insights that will improve cultural safety.
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Affiliation(s)
- Chloe Gao
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lianne L Cho
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Avneet Dhillon
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Soyeon Kim
- Department of Psychiatry, McMaster University, Hamilton, Canada
- Waypoint Research Institute, Waypoint Centre for Mental Healthcare, Penetanguishene, Canada
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael R Law
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nadiya Sunderji
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Skye Barbic
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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3
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Yang Y(S, Law M, Vaghri Z. New Brunswick's mental health action plan: A quantitative exploration of program efficacy in children and youth using the Canadian Community Health Survey. PLoS One 2024; 19:e0301008. [PMID: 38848408 PMCID: PMC11161078 DOI: 10.1371/journal.pone.0301008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/09/2024] [Indexed: 06/09/2024] Open
Abstract
In 2011, the New Brunswick government released the New Brunswick Mental Health Action Plan 2011-2018 (Action Plan). Following the release of the Action Plan in 2011, two progress reports were released in 2013 and 2015, highlighting the implementation status of the Action Plan. While vague in their language, these reports indicated considerable progress in implementing the Action Plan, as various initiatives were undertaken to raise awareness and provide additional resources to facilitate early prevention and intervention in children and youth. However, whether these initiatives have yielded measurable improvements in population-level mental health outcomes in children and youth remains unclear. The current study explored the impact of the Action Plan by visualizing the trend in psychosocial outcomes and service utilization of vulnerable populations in New Brunswick before and after the implementation of the Action Plan using multiple datasets from the Canadian Community Health Survey. Survey-weighted ordinary least square regression analyses were performed to investigate measurable improvements in available mental health outcomes. The result revealed a declining trend in the mental wellness of vulnerable youth despite them consistently reporting higher frequencies of mental health service use. This study highlights the need for a concerted effort in providing effective mental health services to New Brunswick youth and, more broadly, Canadian youth, as well as ensuring rigorous routine outcome monitoring and evaluation plans are consistently implemented for future mental health strategies at the time of their initiation.
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Affiliation(s)
- Yuzhi (Stanford) Yang
- Department of Psychology, Faculty of Science, Applied Science, and Engineering, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Moira Law
- Department of Psychology, Faculty of Science, St. Mary’s University, Halifax, Nova Scotia, Canada
| | - Ziba Vaghri
- Global Child Program, Integrated Health Initiative, Faculty of Business, University of New Brunswick, Saint John, New Brunswick, Canada
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4
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Rao S, Dimitropoulos G, Jardine R, Quickstad J, Satam L, Qureshi M, Bui T, Todorova AA, Tumaneng Y, Suthakaran A, Dalley K, Smith S, Patten SB. Primus Inter PARES: First among equals-practical strategies for young adult PAtient RESearch partners (PARES) by young adult PARES. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:45. [PMID: 38720386 PMCID: PMC11077772 DOI: 10.1186/s40900-024-00576-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/18/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND This manuscript is coauthored by 15 young adult Patient RESearch partners (PARES) with lived and living mental health experiences and three institutional researchers across Canada involved in a patient-oriented research (POR) study called the HEARTS Study: Helping Enable Access and Remove Barriers To Support for Young Adults with Mental Health-Related Disabilities. We share our reflections, experiences and lessons learned as we grapple with the field of POR for its lack of clarity, hierarchical structures, internalized ableism, and accessibility challenges, among others. To mitigate the difficulties of POR, we started by laying the groundwork for equality by embracing the principle of Primus Inter Pares: First Among Equals as the foundation of our approach. In this way, we began with what we know for certain: the inherent worth and dignity of young adults as equal partners, recognizing their expertise, worldviews, creativity, and capacity to contribute meaningfully and intentionally to the research that affects their lives and futures. MAIN BODY The manuscript underscores the need to reconceptualize meaningful engagement in POR, advocating a shift from traditional, biased paradigms that fail to address the complexities faced by young adults with mental illness. It introduces what we have termed Adaptive and Differential Engagement, underscoring the necessity of tailoring participation to individual preferences and circumstances alongside a Tripartite Compensation model that promotes fair and holistic remuneration in research collaborations. Then we discuss the approaches we have conceptualized, such as Equitable Dialogue, Trust Architecture, Community Continuum, Unity in Diversity, Shared Stewardship, and Agile Frameworks that collectively aim to overcome barriers like language intimidation, power imbalances, framework fatigue, consultation burnout, trust deficits, and systemic discrimination and exclusion. The manuscript does not seek to prescribe any universal or standardized solutions; in fact, it seeks the opposite. Instead, it offers a thoughtful and transparent contribution to the POR canon, providing resources for young adults eager to engage in research and institutional researchers aspiring to collaborate with them. CONCLUSION This manuscript is a product of our collective learning and critical self-evaluation. By integrating theoretical insights with practical strategies, we present a justice-oriented blueprint for an inclusive and egalitarian approach to POR. We advocate for applications of POR that are responsive to the individualized contexts of young adult PARES, ensuring their perspectives are central to the research with the resources to take the lead should they choose.
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Affiliation(s)
- Sandy Rao
- Faculty of Social Work, University of Calgary, Calgary, Canada.
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada.
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada
| | - Rae Jardine
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Julien Quickstad
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Laetitia Satam
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
- University of Alberta, Edmonton, AB, Canada
| | - Mohammad Qureshi
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Thyra Bui
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Antoaneta Alexandrova Todorova
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ysabelle Tumaneng
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Abitha Suthakaran
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Kaiden Dalley
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
| | - Stacie Smith
- Mental Health Accessibility and Policy Solutions Lab, Mississauga, ON, Canada
- Faculty of Education, Mount Saint Vincent University, Halifax, NS, Canada
| | - Scott B Patten
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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5
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Adu J, Fordjour Owusu M, Martin-Yeboah E, Gyamfi S. Analyzing Two Decades of Literature on Experiences of Familial Mental Illness Stigma in Four Advanced Countries (2000-2020). Issues Ment Health Nurs 2024; 45:247-263. [PMID: 38270980 DOI: 10.1080/01612840.2023.2301602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND Mental illness-related stigma does not only emanate from the public but also within families of persons with mental illnesses. Familial mental illness stigma implies family members perpetuating stigma against their loved ones with mental illnesses. AIMS The aim of this review was to analyze the empirical literature on experiences of familial mental illness stigma in four countries. METHODS Using seven databases, we reviewed 133 empirical studies with 26 meeting the inclusion criteria. Each of the 26 studies spoke to various forms of familial mental illness stigma that potentially impact the self-esteem and self-worth of the affected person. RESULTS Findings from this review show the existence of familial mental illness stigma in high-income countries, highlighting the need for evidence-based policies to safeguard affected persons at the family level. Close relatives stigmatizing their loved ones due to mental illnesses have contributed to the concealment of mental illness diagnoses within families, which often results in poor prognoses. CONCLUSIONS Family members' understanding of mental illnesses is key in confronting the stigma associated with mental disorders in our communities, but this is contingent on continuous comprehensive familial program and education. Constant social support from community services and family members is essential in the recovery of persons with mental illnesses. This underscores the need for a stigma-free environment at all levels of society to ensure all-inclusiveness which calls for a comprehensive strategy that targets policy changes, public education, and media representations of mental health-related problems.
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Affiliation(s)
- Joseph Adu
- Department of Health and Rehabilitation Sciences, Western University, London, Canada
| | - Mark Fordjour Owusu
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | | | - Sebastian Gyamfi
- Lawson Health Research Institute, London, Canada
- Faculty of Nursing, Windsor University, Windsor, Canada
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Słowiński P, White A, Lison S, Sullivan S, Emmens T, Self P, Wileman J, Karl A, Tsaneva-Atanasova K. The potential of digital behavioural tests as a diagnostic aid for psychosis. PLOS DIGITAL HEALTH 2023; 2:e0000339. [PMID: 37713385 PMCID: PMC10503702 DOI: 10.1371/journal.pdig.0000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/29/2023] [Indexed: 09/17/2023]
Abstract
Timely interventions have a proven benefit for people experiencing psychotic illness. One bottleneck to accessing timely interventions is the referral process to the specialist team for early psychosis (STEP). Many general practitioners lack awareness or confidence in recognising psychotic symptoms or state. Additionally, referrals for people without apparent psychotic symptoms, although beneficial at a population level, lead to excessive workload for STEPs. There is a clear unmet need for accurate stratification of STEPs users and healthy cohorts. Here we propose a new approach to addressing this need via the application of digital behavioural tests. To demonstrate that digital behavioural tests can be used to discriminate between the STEPs users (SU; n = 32) and controls (n = 32, age and sex matched), we compared performance of five different classifiers applied to objective, quantitative and interpretable features derived from the 'mirror game' (MG) and trail making task (TMT). The MG is a movement coordination task shown to be a potential socio-motor biomarker of schizophrenia, while TMT is a neuropsychiatric test of cognitive function. All classifiers had AUC in the range of 0.84-0.92. The best of the five classifiers (linear discriminant classifier) achieved an outstanding performance, AUC = 0.92 (95%CI 0.75-1), Sensitivity = 0.75 (95%CI 0.5-1), Specificity = 1 (95%CI 0.75-1), evaluated on 25% hold-out and 1000 folds. Performance of all analysed classifiers is underpinned by the large effect sizes of the differences between the cohorts in terms of the features used for classification what ensures generalisability of the results. We also found that MG and TMT are unsuitable in isolation to successfully differentiate between SU with and without at-risk-mental-state or first episode psychosis with sufficient level of performance. Our findings show that standardised batteries of digital behavioural tests could benefit both clinical and research practice. Including digital behavioural tests into healthcare practice could allow precise phenotyping and stratification of the highly heterogenous population of people referred to STEPs resulting in quicker and more personalised diagnosis. Moreover, the high specificity of digital behavioural tests could facilitate the identification of more homogeneous clinical high-risk populations, benefiting research on prognostic instruments for psychosis. In summary, our study demonstrates that cheap off-the-shelf equipment (laptop computer and a leap motion sensor) can be used to record clinically relevant behavioural data that could be utilised in digital mental health applications.
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Affiliation(s)
- Piotr Słowiński
- Translational Research Exchange @ Exeter, Living Systems Institute, Department of Mathematics and Statistics, Faculty of Environment, Science and Economy, University of Exeter, United Kingdom
| | - Alexander White
- Department of Psychology, Faculty of Health and Life Sciences, University of Exeter, United Kingdom
| | - Sian Lison
- Research & Development Department, Devon Partnership NHS Trust, Exeter, United Kingdom
| | - Sarah Sullivan
- Faculty of Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Tobit Emmens
- Research & Development Department, Devon Partnership NHS Trust, Exeter, United Kingdom
| | - Philip Self
- Research & Development Department, Devon Partnership NHS Trust, Exeter, United Kingdom
| | - Jane Wileman
- Specialist Team for Early Psychosis, Devon Partnership NHS Trust, Exeter, United Kingdom
| | - Anke Karl
- Department of Psychology, Faculty of Health and Life Sciences, University of Exeter, United Kingdom
| | - Krasimira Tsaneva-Atanasova
- Translational Research Exchange @ Exeter, Living Systems Institute, Department of Mathematics and Statistics, Faculty of Environment, Science and Economy, University of Exeter, United Kingdom
- EPSRC Hub for Quantitative Modelling in Healthcare University of Exeter, Exeter, United Kingdom
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Shah JL, Moinfar Z, Anderson KK, Gould H, Hutt-Macleod D, Jacobs P, Mitchell S, Nguyen T, Rodrigues R, Reaume-Zimmer P, Rudderham H, Rudderham S, Smyth R, Surood S, Urichuk L, Malla AK, Iyer SN, Latimer E. Return on investment from service transformation for young people experiencing mental health problems: Approach to economic evaluations in ACCESS Open Minds (Esprits ouverts), a multi-site pan-Canadian youth mental health project. Front Psychiatry 2023; 14:1030407. [PMID: 36896344 PMCID: PMC9988897 DOI: 10.3389/fpsyt.2023.1030407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/03/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION Mental health problems are common globally, and typically have their onset in adolescence and early adulthood-making youth (aged 11-25) an optimal target for prevention and early intervention efforts. While increasing numbers of youth mental health (YMH) initiatives are now underway, thus far few have been subject to economic evaluations. Here we describe an approach to determining the return on investment of YMH service transformation via the pan-Canadian ACCESS Open Minds (AOM) project, for which a key focus is on improving access to mental health care and reducing unmet need in community settings. APPROACH As a complex intervention package, it is hoped that the AOM transformation will: (i) enable early intervention through accessible, community-based services; (ii) shift care away toward these primary/community settings and away from acute hospital and emergency services; and (iii) offset at least some of the increased costs of primary care/community-based mental health services with reductions in the volume of more resource-intensive acute, emergency, hospital or specialist services utilized. Co-designed with three diverse sites that represent different Canadian contexts, a return on investment analysis will (separately at each site) compare the costs generated by the intervention, including volumes and expenditures associated with the AOM service transformation and any contemporaneous changes in acute, emergency, hospital or service utilization (vs. historical or parallel comparators). Available data from health system partners are being mobilized to assess these hypotheses. ANTICIPATED RESULTS Across urban, semi-urban and Indigenous sites, the additional costs of the AOM transformation and its implementation in community settings are expected to be at least partially offset by a reduction in the need for acute, emergency, hospital or specialist care. DISCUSSION Complex interventions such as AOM aim to shift care "upstream": away from acute, emergency, hospital and specialist services and toward community-based programming which is more easily accessible, often more appropriate for early-stage presentations, and more resource-efficient. Carrying out economic evaluations of such interventions is challenging given the constraints of available data and health system organization. Nonetheless, such analyses can advance knowledge, strengthen stakeholder engagement, and further implementation of this public health priority.
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Affiliation(s)
- Jai L Shah
- ACCESS Open Minds, Douglas Research Centre, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Zeinab Moinfar
- ACCESS Open Minds, Douglas Research Centre, Montreal, QC, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Institute of Clinical and Evaluative Sciences, Toronto, ON, Canada
| | | | | | - Philip Jacobs
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Stephen Mitchell
- Canadian Mental Health Association Lambton Kent, Chatham-Kent, ON, Canada
| | - Thanh Nguyen
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Rebecca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Paula Reaume-Zimmer
- Canadian Mental Health Association Lambton Kent, Chatham-Kent, ON, Canada.,Bluewater Health, Chatham-Kent, ON, Canada
| | | | | | - Rebecca Smyth
- Canadian Mental Health Association Lambton Kent, Chatham-Kent, ON, Canada
| | | | | | - Ashok K Malla
- ACCESS Open Minds, Douglas Research Centre, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Srividya N Iyer
- ACCESS Open Minds, Douglas Research Centre, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Eric Latimer
- ACCESS Open Minds, Douglas Research Centre, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
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Adu J, Oudshoorn A, Van Berkum A, Pervez R, Norman R, Canas E, Virdee M, Yosieph L, MacDougall AG. Review: System transformation to enhance transitional age youth mental health - a scoping review. Child Adolesc Ment Health 2022; 27:399-418. [PMID: 35920392 DOI: 10.1111/camh.12592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Youth mental health challenges are an emerging and persistent global public health issue despite efforts for improvement. As part of a broader social innovation study to transform youth mental health systems, this scoping review assesses interventions that aim for systems-level changes to improve the mental well-being of transitional age youth (TAY) (15-25 years) in high-income countries. METHODS The scoping review method of Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) was used. Seven health and social service databases were utilized with study inclusion criteria applied. Titles and abstracts were screened by two independent reviewers, and four members of the research team were involved in the review and thematic analysis of selected studies. RESULTS A total of 5652 peer-reviewed articles were screened at the title and abstract level, of which 65 were assessed in full for eligibility, and 29 were included for final analysis. The peer-reviewed articles and gray literature were based in seven different high-income countries and published between 2008 and 2019. Four major themes to support youth mental health were identified in the literature: (a) improving transitions from youth to adult mental healthcare services; (b) moving care from institutions to the community; (c) general empowerment of youth in society; and (d) youth voice within the system. Inconsistent or limited systems-level approaches to TAY mental health care were noted. CONCLUSIONS There remains a need for innovative, evidence-based approaches to improve TAY mental health care.
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Affiliation(s)
- Joseph Adu
- Department of Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Abe Oudshoorn
- School of Nursing, Western University, London, ON, Canada
| | - Amy Van Berkum
- School of Nursing, Western University, London, ON, Canada
| | - Romaisa Pervez
- Mental Health Care, Parkwood Institute Research, London, ON, Canada
| | - Ross Norman
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Eugenia Canas
- Faculty of Information and Media Studies, Western University, London, ON, Canada
| | | | - Lily Yosieph
- Mental Health Care, Parkwood Institute Research, London, ON, Canada
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Banandur P, Gopalan K, Pai SG, Arelingaiah M, Velu RS, Garady L, Koujageri JM, Naik V, Sajjanar SL, Ramesh MS, Srinivas K, Gopalkrishna G. Factors affecting relationship issues among clients attending youth mental health promotion services in India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:123. [PMID: 35677259 PMCID: PMC9170197 DOI: 10.4103/jehp.jehp_809_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/02/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND India today is home for the largest youth population in the world. Youth is a formative phase transitioning from childhood to adulthood. Relationship is fundamental for a healthy and satisfactory life. Relationships assume importance and maturity during adolescence and youth. Relationships and mental health have a bidirectional effect. The effect of relationships on mental health is stronger than vice versa. MATERIALS AND METHODS Two-year case record analysis of 8595 beneficiaries aged 15-35 years attending youth guidance centers (Yuva Spandana Kendras) in Karnataka, India, was undertaken to understand factors affecting relationship issues among them. Multivariate logistic regression was performed with any beneficiary having a relationship issue as outcome. RESULTS Being a student (adjusted odds ratio [AOR] = 1.49; 95% confidence interval [CI] = 1.18-1.89), occupation (AORbusiness/salaried = 3.04; 95% CI = 2.10-4.40 and AORothers = 1.72; 95% CI = 1.22-2.44), marital status (AORmarried = 1.42; 95% CI = 1.06-1.90 and AORothers = 3.44; 95% CI = 1.45-8.15), having health and lifestyle issues (AOR = 3.61; 95% CI = 3.05-4.27), personality issues (AOR = 2.88; 95% CI = 2.43-3.41), safety issues (AOR = 6.28; 95% CI = 5.01-7.87), gender, sex, and sexuality issues (AOR = 3.10; 95% CI = 1.93-4.98), suicidality (AOR = 1.82; 95% CI = 1.17-2.85), alcohol use (AOR = 5.43; 95% CI = 3.92-7.41), and different emotions experienced (AOR ranging from 0.37 to 3.50), had significant association with relationship issues. CONCLUSION Investing in health promotion interventions focusing on these precursors of relationship issues among youth seems strategic. Our findings have implications for other states in India and other low-middle-income countries like India.
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Affiliation(s)
- Pradeep Banandur
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Kalpana Gopalan
- Department of Youth Empowerment and Sports, Government of Karnataka, Bengaluru, Karnataka, India
| | - Shikha G. Pai
- Department of Psychology, APS University, Rewa, Madhya Pradesh, India
| | - Mutharaju Arelingaiah
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - R. Sathya Velu
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Lavanya Garady
- Department of International Centre for Public Health Innovations, RAMAIAH, Bengaluru, Karnataka, India
| | - Jyoti M. Koujageri
- Management and Commerce, CMR Institute of Management Studies, Bengaluru, Karnataka, India
| | - Vani Naik
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Sateesh L. Sajjanar
- Department of Youth Empowerment and Sports, Government of Karnataka, Bengaluru, Karnataka, India
| | - M. S. Ramesh
- Department of Youth Empowerment and Sports, Government of Karnataka, Bengaluru, Karnataka, India
| | - K. Srinivas
- Department of Youth Empowerment and Sports, Government of Karnataka, Bengaluru, Karnataka, India
| | - Gururaj Gopalkrishna
- Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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10
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McGorry PD, Mei C, Chanen A, Hodges C, Alvarez-Jimenez M, Killackey E. Designing and scaling up integrated youth mental health care. World Psychiatry 2022; 21:61-76. [PMID: 35015367 PMCID: PMC8751571 DOI: 10.1002/wps.20938] [Citation(s) in RCA: 131] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mental ill-health represents the main threat to the health, survival and future potential of young people around the world. There are indications that this is a rising tide of vulnerability and need for care, a trend that has been augmented by the COVID-19 pandemic. It represents a global public health crisis, which not only demands a deep and sophisticated understanding of possible targets for prevention, but also urgent reform and investment in the provision of developmentally appropriate clinical care. Despite having the greatest level of need, and potential to benefit, adolescents and emerging adults have the worst access to timely and quality mental health care. How is this global crisis to be addressed? Since the start of the century, a range of co-designed youth mental health strategies and innovations have emerged. These range from digital platforms, through to new models of primary care to new services for potentially severe mental illness, which must be locally adapted according to the availability of resources, workforce, cultural factors and health financing patterns. The fulcrum of this progress is the advent of broad-spectrum, integrated primary youth mental health care services. They represent a blueprint and beach-head for an overdue global system reform. While resources will vary across settings, the mental health needs of young people are largely universal, and underpin a set of fundamental principles and design features. These include establishing an accessible, "soft entry" youth primary care platform with digital support, where young people are valued and essential partners in the design, operation, management and evaluation of the service. Global progress achieved to date in implementing integrated youth mental health care has highlighted that these services are being accessed by young people with genuine and substantial mental health needs, that they are benefiting from them, and that both these young people and their families are highly satisfied with the services they receive. However, we are still at base camp and these primary care platforms need to be scaled up across the globe, complemented by prevention, digital platforms and, crucially, more specialized care for complex and persistent conditions, aligned to this transitional age range (from approximately 12 to 25 years). The rising tide of mental ill-health in young people globally demands that this focus be elevated to a top priority in global health.
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Affiliation(s)
- Patrick D McGorry
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Cristina Mei
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Andrew Chanen
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Craig Hodges
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Eóin Killackey
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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11
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Adu J, Oudshoorn A, Anderson K, Marshall CA, Stuart H, Stanley M. Policies and Interventions to Reduce Familial Mental Illness Stigma: A Scoping Review of Empirical Literature. Issues Ment Health Nurs 2021; 42:1123-1137. [PMID: 34319817 DOI: 10.1080/01612840.2021.1936710] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although research to date has shown that there can be no health or sustainable development without good mental health, mental illness continues to significantly impact societies. A major challenge confronting people with mental illnesses and their families is the stigma that they endure. In this study, empirical literature was reviewed to assess policies and interventions that seek to reduce familial mental illness stigma across four countries. We used Arksey and O'Malley methodological framework, and a qualitative content analysis was employed to augment the descriptive data extracted. Seven studies published between 2000 and 2020 were analyzed. We propose herein three themes that align with interventions to reduce familial mental illness stigma: transformative education, sharing and disclosure, and social networking and support. The findings indicate that persuasive and purposeful education directed at the public to correct misconceptions surrounding mental illness, with attention to language, may help in reducing familial mental illness stigma. Disclosure of mental illness is encouraged among persons with mental illnesses and their families as a strategy to enhance mutual understanding. Social sharing also affords persons with mental illnesses opportunities to engage with their peers at different levels within the public sphere. Apart from these recommendations, we have noted a paucity of broad governmental-level policies and interventions to comprehensively address the negative attitudes of families toward their relatives. Future work must address this gap to identify effective interventions to create healthier and supportive environments that address familial mental illness stigma.
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Affiliation(s)
- Joseph Adu
- Department of Health and Rehabilitation Sciences, Elborn College, Western University, London, Ontario, Canada
| | - Abram Oudshoorn
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Kelly Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Carrie Anne Marshall
- School of Occupational Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Heather Stuart
- Department of Public Health Sciences, Department of Psychiatry, and the School of Rehabilitation Therapy, Queens University, Kingston, Ontario, Canada
| | - Meagan Stanley
- Teaching and Learning Librarian, Health & Medicine Disciplinary Coordinator, Western University, London, Ontario, Canada
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12
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Canas E, Wathen N, Berman H, Reaume-Zimmer P, Iyer SN. Our roles are not at ease: The work of engaging a youth advisory council in a mental health services delivery organization. Health Expect 2021; 24:1618-1625. [PMID: 34240785 PMCID: PMC8483197 DOI: 10.1111/hex.13302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/11/2021] [Accepted: 05/07/2021] [Indexed: 12/01/2022] Open
Abstract
Objectives There is growing policy impetus for including youth voices in health services research and health system reform. This article examines the perspectives of professionals in a mental healthcare organization charged with engaging young people as advisors in service transformation. Methods An institutional ethnography of a youth mental health services organization in Ontario, Canada, was conducted. Fieldwork consisted of twelve months of observation of meetings, interviews with youth advisors and adult service providers, with subsequent text analysis of engagement training and policy materials. The present article reports data from six adult professionals and related field observations. Results Service providers’ efforts to engage youth were observed in three areas: a) supporting youth's development as advisors, b) retaining and deepening youth participation while waiting for organizational change and c) embedding relationships between youth and adults at various levels within the system of care. This work denotes existing tensions between the values and ideals of youth engagement and the everyday demands of services delivery. Conclusion In this setting, a fundamental dimension of this work consisted of negotiating tensions between the policy enthusiasm for engagement and its realization in a health services context. In describing these contextual challenges, we outline implications for consideration by other youth mental health services. Engagement efforts that are authentic and sustained require resources and flexibility, and leadership commitment to instil service users’ perspectives throughout multiple levels within the organization.
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Affiliation(s)
- Eugenia Canas
- Faculty of Information & Media Studies, Western University, London, ON, Canada
| | - Nadine Wathen
- Faculty of Information & Media Studies, Western University, London, ON, Canada.,Centre for Research and Education on Violence Against Women and Children, Western University, London, ON, Canada
| | - Helene Berman
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.,Centre for Research on Health Equity and Social Inclusion, Western University, London, ON, Canada
| | - Paula Reaume-Zimmer
- Mental Health and Addiction Services, Bluewater Health and Canadian Mental Health Association, Lambton Kent, ON, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Research Centre, Montréal, QC, Canada
| | - Srividya N Iyer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Research Centre, Montréal, QC, Canada.,Department of Psychiatry, McGill University, Montréal, QC, Canada.,Douglas Mental Health University Institute, Montréal, QC, Canada
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13
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Catanzano M, Bennett SD, Tibber MS, Coughtrey AE, Liang H, Heyman I, Shafran R. A Mental Health Drop-In Centre Offering Brief Transdiagnostic Psychological Assessment and Treatment in a Paediatric Hospital Setting: A One-Year Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105369. [PMID: 34069973 PMCID: PMC8157880 DOI: 10.3390/ijerph18105369] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
AIM This study was part of a broader project to examine the acceptability, feasibility and impact of a transdiagnostic mental health drop-in centre offering brief psychological assessment and treatment for children and young people and/or their families with mental health needs in the context of long-term physical health conditions (LTCs). The aims of this investigation were to characterise: (i) the use of such a centre, (ii) the demographics and symptoms of those presenting to the centre, and (iii) the types of support that are requested and/or indicated. METHODS A mental health "booth" was located in reception of a national paediatric hospital over one year. Characteristics of young people with LTCs and their siblings/parents attending the booth were defined. Emotional/behavioural symptoms were measured using standardised questionnaires including the Strengths and Difficulties Questionnaire (SDQ). Participants subsequently received one of four categories of intervention: brief transdiagnostic cognitive behaviour therapy (CBT), referral to other services, neurodevelopmental assessment or signposting to resources. RESULTS One hundred and twenty-eight participants were recruited. The mean age of young people was 9.14 years (standard deviation: 4.28); 61% identified as white and 45% were male. Over half of young people recruited scored in the clinical range with respect to the SDQ. Presenting problems included: anxiety (49%), challenging behaviour (35%), low mood (22%) and other (15%). CONCLUSIONS A considerable proportion of young people with LTC in a paediatric hospital scored in the clinical range for common mental health problems, indicating a potential for psychological interventions.
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Affiliation(s)
- Matteo Catanzano
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
- Correspondence: ; Tel.: +44-(0)20-7405-9200
| | - Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Marc S Tibber
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK;
| | - Anna E Coughtrey
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Holan Liang
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - The Lucy Project Team
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK; (S.D.B.); (A.E.C.); (H.L.); (I.H.); (T.L.P.T.); (R.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK
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14
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Sheikhan NY, Hawke LD, Cleverley K, Darnay K, Courey L, Szatmari P, Cheung A, Henderson J. 'It reshaped how I will do research': A qualitative exploration of team members' experiences with youth and family engagement in a randomized controlled trial. Health Expect 2021; 24:589-600. [PMID: 33587827 PMCID: PMC8077141 DOI: 10.1111/hex.13206] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/12/2021] [Accepted: 01/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background Engaging youth and family members as active partners in research and service design offers great promise in improving projects. In youth mental health, recent research has highlighted the value of youth and family engagement. However, research on the experience and impacts of engagement is sparse. Objective This study explores the project team's experience of youth and family engagement in the design and development of the YouthCan IMPACT randomized controlled trial and clinical service pathway design. Design Qualitative data collected using semi‐structured interviews and a focus group as part of the YouthCan IMPACT clinical trial were analysed to understand the impacts of engagement. Twenty‐eight team members were interviewed, including youth and family members. A qualitative content analysis was conducted, with a member checking process. Results Team members reported facilitators, barriers and impacts of youth and family engagement. Facilitators included a safe environment and strong procedures conducive to inclusion in co‐design. Barriers included logistical, structural and institutional constraints. Overall, team members found youth and family engagement to be valuable and to positively impact the research and service design process. Discussion and Conclusions Youth and family engagement played a critical role in research and clinical service pathway design. The team found that their involvement improved the quality of the research and service pathway through sustained and multifaceted engagement. Facilitators and barriers to engagement may serve to guide future engagement initiatives. Future research should evaluate the long‐term impact of early engagement and further focus on family engagement. Patient/Public Contribution Youth and family members were engaged in the data analysis and interpretation process.
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Affiliation(s)
| | - Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kristin Cleverley
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Karleigh Darnay
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lynn Courey
- Sashbear Foundation, Toronto, Ontario, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Amy Cheung
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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15
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Ferrari M, McIlwaine SV, Reynolds JA, Archie S, Boydell K, Lal S, Shah JL, Henderson J, Alvarez-Jimenez M, Andersson N, Boruff J, Nielsen RKL, Iyer SN. Digital Game Interventions for Youth Mental Health Services (Gaming My Way to Recovery): Protocol for a Scoping Review. JMIR Res Protoc 2020; 9:e13834. [PMID: 32579117 PMCID: PMC7381025 DOI: 10.2196/13834] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 01/05/2023] Open
Abstract
Background Digital or video games are played by millions of adolescents and young adults around the world and are one of the technologies used by youths to access mental health services. Youths with mental health problems strongly endorse the use of technologies, including mobile and online platforms, to receive information, support their treatment journeys (eg, decision-making tools), and facilitate recovery. A growing body of literature explores the advantages of playing digital games for improving attention span and memory, managing emotions, promoting behavior change, and supporting treatment for mental illness (eg, anxiety, depression, or posttraumatic stress disorder). The research field has also focused on the negative impact of video games, describing potential harms related to aggression, addiction, and depression. To promote clarity on this matter, there is a great need for knowledge synthesis offering recommendations on how video games can be safely and effectively adopted and integrated into youth mental health services. Objective The Gaming My Way to Recovery scoping review project assesses existing evidence on the use of digital game interventions within the context of mental health services for youths (aged 11-29 years) using the stepped care model as the conceptual framework. The research question is as follows: For which youth mental health conditions have digital games been used and what broad objectives (eg, prevention, treatment) have they addressed? Methods Using the methodology proposed by Arksey and O’Malley, this scoping review will map the available evidence on the use of digital games for youths between 11 and 29 years old with mental health or substance use problems, or both. Results The review will bring together evidence-based knowledge to assist mental health providers and policymakers in evaluating the potential benefits and risks of these interventions. Following funding of the project in September 2018, we completed the search in November 2018, and carried out data screening and stakeholder engagement activities during preparation of the protocol. We will conduct a knowledge synthesis based on specific disorders, treatment level and modality, type of service, population, settings, ethical practices, and user engagement and offer recommendations concerning the integration of video game technologies and programs, future research and practice, and knowledge dissemination. Conclusions Digital game interventions employ unique, experiential, and interactive features that potentially improve skills and facilitate learning among players. Digital games may also provide a new treatment platform for youths with mental health conditions. Assessing current knowledge on video game technology and interventions may potentially improve the range of interventions offered by youth mental health services while supporting prevention, intervention, and treatment. International Registered Report Identifier (IRRID) PRR1-10.2196/13834
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Affiliation(s)
- Manuela Ferrari
- Douglas Mental Health University Institute, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | | | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | | | - Shalini Lal
- Douglas Mental Health University Institute, Montreal, QC, Canada.,School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.,Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
| | - Jai L Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | | | | | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Jill Boruff
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
| | | | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada
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16
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Lal S, Starcevic DJ, Fuhrer R. Youth Experiences With Referrals to Mental Health Services in Canada: Protocol for a Web-Based Cross-Sectional Survey Study. JMIR Res Protoc 2020; 9:e16945. [PMID: 32207698 PMCID: PMC7139421 DOI: 10.2196/16945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 01/01/2023] Open
Abstract
Background Youth mental health is an important public health concern affecting low-, middle-, and high-income countries, and many young people in need of mental health services do not receive the care they need when they need it. An early step in accessing mental health care is the referral process, yet most of the research done on pathways to care has focused on clinical populations (eg, first-episode psychosis) recruited from mental health care settings. There has been limited research attention on the experiences of referral to mental health services from the perspectives of youth recruited from the general population who may or may not have received the services they need. Objective This study aims to investigate the experiences that youth between the ages of 17 and 30 years have with referrals to mental health services and to better understand their perspectives on the use of technology to facilitate referrals. Methods This study will use a cross-sectional, Web-based survey design. A convenience sample of 400 participants from 3 Canadian provinces (Quebec, Ontario, and British Columbia), between the ages of 17 and 30 years, will be recruited via Facebook and will be invited to complete a Web-based survey anonymously. A questionnaire including a series of quantitative and qualitative questions will ask participants about their sociodemographic characteristics, past experiences with referral and access to mental health services, and opinions about using technology to facilitate the referral process. Results Participant recruitment is planned to be initiated by early January 2020 and is estimated to be completed by May 2020. Data will be analyzed using descriptive statistics and logistic regression or chi-square tests for quantitative data, and descriptive content analysis will be used for the qualitative data. Conclusions The results of this study can help inform the improvement of referral policies and procedures in youth mental health service delivery. A better understanding of young people’s perspectives on referral processes and their opinions on how these processes can be improved are essential to providing appropriate and timely access to mental health care. International Registered Report Identifier (IRRID) PRR1-10.2196/16945
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Affiliation(s)
- Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada.,Youth Mental Health and Technology Lab, University of Montréal Hospital Research Centre, Montréal, QC, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, QC, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Danielle Joanna Starcevic
- Youth Mental Health and Technology Lab, University of Montréal Hospital Research Centre, Montréal, QC, Canada.,Dept of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Rebecca Fuhrer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, QC, Canada.,Dept of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada
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17
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Morisseau-Guillot R, Aubin D, Deschênes JM, Gioia M, Malla A, Bauco P, Dupont MÈ, Abdel-Baki A. A Promising Route Towards Improvement of Homeless Young People's Access to Mental Health Services: The Creation and Evolution of an Outreach Service Network in Montréal. Community Ment Health J 2020; 56:258-270. [PMID: 31606765 DOI: 10.1007/s10597-019-00456-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 09/07/2019] [Indexed: 11/28/2022]
Abstract
Youth homelessness is a complex phenomenon as well as an important public health issue often compounded by mental illness of varying severity, in turn creating numerous deleterious consequences. While emergency health services usage remains high, access to mental health services is arduous and conventional interventions often fall short on providing integrated care and seldom lead to sustained positive outcomes for this group. From this observation, clinicians in Montreal, Canada, initiated collaborative meetings, eventually attended by a growing number of institutional and community stakeholders working with homeless youth. Acknowledging the unique needs of this population, the Réseau d'intervention de proximité auprès des Jeunes de la Rue (RIPAJ) or Montreal Homeless Youth Network was created to engage and seamlessly connect youth with the right resources within the network including mental health services amongst others. The genesis, philosophy and unique features of RIPAJ that allow for effective and cohesive interventions as well as future directions are discussed.
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Affiliation(s)
- Raphaël Morisseau-Guillot
- Department of Psychiatry, Faculty of Medicine, University of Montréal, C.P. 6128 Centre-Ville, Montréal, QC, H3C 3J7, Canada
| | - Diane Aubin
- Dans La Rue, 533 Ontario Street East, Suite 450, Montréal, QC, H2L 1N8, Canada
| | - Julie-Marguerite Deschênes
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 1000 St-Denis Street, Montréal, QC, H2X 3E4, Canada
| | - Milena Gioia
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 1000 St-Denis Street, Montréal, QC, H2X 3E4, Canada
| | - Ashok Malla
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada
| | - Pasquale Bauco
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 1000 St-Denis Street, Montréal, QC, H2X 3E4, Canada
| | - Marie-Ève Dupont
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 1000 St-Denis Street, Montréal, QC, H2X 3E4, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry, Faculty of Medicine, University of Montréal, C.P. 6128 Centre-Ville, Montréal, QC, H3C 3J7, Canada. .,Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), 1000 St-Denis Street, Montréal, QC, H2X 3E4, Canada.
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18
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Campbell LA, Clark SE, Ayn C, Chorney J, Emberly D, MacDonald J, MacKenzie A, Marsh D, Peacock K, Wozney L. The Choice and Partnership Approach to community mental health and addictions services: a realist-informed scoping review protocol. BMJ Open 2019; 9:e033247. [PMID: 31874887 PMCID: PMC7008451 DOI: 10.1136/bmjopen-2019-033247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/25/2019] [Accepted: 11/18/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Early identification and appropriate treatment of child and adolescent mental health disorders can often be hampered by patchwork services with poorly planned or unclear pathways. The Choice and Partnership Approach (CAPA) is an evidence-based transformational model of community (community-based or outpatient) mental health and addictions services for children and adolescents that aims to better match services to needs and to improve timely access to care. CAPA has been variably implemented across jurisdictions but has not been comprehensively evaluated for its impact on system and client outcomes. Our research question is, 'To what degree does CAPA work, for whom and under what circumstances?'. The purpose of this review is twofold: (1) to gain an understanding of the extent and outcomes of the implementation of CAPA in community mental health and addictions services; and (2) to identify the role of context as it influences the implementation of CAPA and resulting client and system outcomes. METHODS AND ANALYSIS We will conduct a realist-informed scoping review of the literature related to CAPA in either child and adolescent or adult community mental health and addictions services. Relevant studies, reports and documentation will be identified by searching the following online databases: MEDLINE, Embase, CINAHL, PsycINFO, Academic Search Premier, ERIC, Web of Science, Cochrane, Dissertations Abstracts, NCBI Bookshelf, PubMed Central and the Canadian Health Research Collection. The search strategy was developed by a health sciences library scientist and informed by a multidisciplinary team comprising methodological and content knowledge experts. The search will gather evidence from multiple online databases of peer-reviewed literature and grey literature repositories. All articles will be independently assessed for inclusion by pairs of reviewers. The key themes derived from a thematic analysis of extracted data will be presented in a narrative overview. ETHICS AND DISSEMINATION Research ethics review is not required for this scoping review. The results will be disseminated through meetings with stakeholders (including clients and families, clinicians and decision-makers), conference presentations and peer-reviewed publication. The results of this review will inform an overarching programme of research, policy and quality indicator development to ultimately improve mental health and addictions care and subsequent mental health outcomes for children and adolescents.
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Affiliation(s)
- Leslie Anne Campbell
- Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Psychiatry, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Sharon E Clark
- Mental Health and Addictions, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Caitlyn Ayn
- Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jill Chorney
- Mental Health and Addictions, IWK Health Centre, Halifax, Nova Scotia, Canada
- Anesthesia, Pain Management & Perioperative Medicine, and Psychology & Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Debbie Emberly
- Mental Health and Addictions, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Julie MacDonald
- Mental Health and Addictions, Nova Scotia Health Authority, Sydney, Nova Scotia, Canada
| | - Adrian MacKenzie
- Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Health Workforce Planning and Regulatory Affairs Branch, Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Daniel Marsh
- Administration, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Kylie Peacock
- Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lori Wozney
- Mental Health and Addictions, Nova Scotia Health Authority, Dartmouth, Nova Scotia, Canada
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19
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Iyer SN, Shah J, Boksa P, Lal S, Joober R, Andersson N, Fuhrer R, Abdel-Baki A, Beaton AM, Reaume-Zimmer P, Hutt-MacLeod D, Levasseur MA, Chandrasena R, Rousseau C, Torrie J, Etter M, Vallianatos H, Abba-Aji A, Bighead S, MacKinnon A, Malla AK. A minimum evaluation protocol and stepped-wedge cluster randomized trial of ACCESS Open Minds, a large Canadian youth mental health services transformation project. BMC Psychiatry 2019; 19:273. [PMID: 31488144 PMCID: PMC6729084 DOI: 10.1186/s12888-019-2232-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/07/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Many Canadian adolescents and young adults with mental health problems face delayed detection, long waiting lists, poorly accessible services, care of inconsistent quality and abrupt or absent inter-service transitions. To address these issues, ACCESS Open Minds, a multi-stakeholder network, is implementing and systematically evaluating a transformation of mental health services for youth aged 11 to 25 at 14 sites across Canada. The transformation plan has five key foci: early identification, rapid access, appropriate care, the elimination of age-based transitions between services, and the engagement of youth and families. METHODS The ACCESS Open Minds Research Protocol has multiple components including a minimum evaluation protocol and a stepped-wedge cluster randomized trial, that are detailed in this paper. Additional components include qualitative methods and cost-effectiveness analyses. The services transformation is being evaluated at all sites via a minimum evaluation protocol. Six sites are participating in the stepped-wedge trial whereby the intervention (a service transformation along the key foci) was rolled out in three waves, each commencing six months apart. Two sites, one high-population and one low-population, were randomly assigned to each of the three waves, i.e., randomization was stratified by population size. Our primary hypotheses pertain to increased referral numbers, and reduced wait times to initial assessment and to the commencement of appropriate care. Secondary hypotheses pertain to simplified pathways to care; improved clinical, functional and subjective outcomes; and increased satisfaction among youth and families. Quantitative measures addressing these hypotheses are being used to determine the effectiveness of the intervention. DISCUSSION Data from our overall research strategy will help test the effectiveness of the ACCESS Open Minds transformation, refine it further, and inform its scale-up. The process by which our research strategy was developed has implications for the practice of research itself in that it highlights the need to actively engage all stakeholder groups and address unique considerations in designing evaluations of complex healthcare interventions in multiple, diverse contexts. Our approach will generate both concrete evidence and nuanced insights, including about the challenges of conducting research in real-world settings. More such innovative approaches are needed to advance youth mental health services research. TRIAL REGISTRATION NUMBER Clinicaltrials.gov, ISRCTN23349893 (Retrospectively registered: 16/02/2017).
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Affiliation(s)
- Srividya N. Iyer
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, Québec Canada
- Douglas Mental Health University Institute, Montréal, Québec Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec Canada
| | - Jai Shah
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, Québec Canada
- Douglas Mental Health University Institute, Montréal, Québec Canada
| | - Patricia Boksa
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Douglas Mental Health University Institute, Montréal, Québec Canada
| | - Shalini Lal
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec Canada
- Centre de recherche du Centre hospitalier de l’Universite de Montreal (CRCHUM), Montréal, Québec Canada
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, Québec Canada
- Douglas Mental Health University Institute, Montréal, Québec Canada
| | - Neil Andersson
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Department of Family Medicine, Community Information and Epidemiological Technologies (CIET) Institute and Participatory Research at McGill (PRAM), McGill University, Montréal, Québec Canada
- McGill University Institute for Human Development and Well-being, Montréal, Québec Canada
| | - Rebecca Fuhrer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec Canada
| | - Amal Abdel-Baki
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Centre de recherche du Centre hospitalier de l’Universite de Montreal (CRCHUM), Montréal, Québec Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec Canada
- Centre hospitalier de l’Université de Montréal (CHUM), CRCHUM, Montréal, Québec Canada
| | - Ann M. Beaton
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- School of Psychology, Faculty of Health Sciences and Community Services, Université de Moncton, Moncton, New Brunswick, Canada
| | - Paula Reaume-Zimmer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Mental Health and Addictions Services, Bluewater Health and Canadian Mental Health Association, Lambton Kent, Ontario, Canada
| | - Daphne Hutt-MacLeod
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Eskasoni Mental Health Services, Eskasoni First Nation, Nova Scotia, Canada
| | - Mary Anne Levasseur
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- ACCESS Open Minds Family and Carers Council, Douglas Mental Health University Institute, Montréal, Québec Canada
| | - Ranjith Chandrasena
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Schulich School of Medicine, Western University, London, Ontario Canada
| | - Cécile Rousseau
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Centre de recherche SHERPA, Institut Universitaire au regard des communautés ethno culturelles, Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Ouest-de-l’Île-de-Montreal, Montréal, Québec Canada
| | - Jill Torrie
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Public Health Department, Cree Board of Health and Social Services of James Bay, Cree Nation of Mistissini, Québec Canada
| | - Meghan Etter
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Counselling Services, Inuvialuit Regional Corporation, Inuvik, Northwest Territories, Canada
| | - Helen Vallianatos
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Department of Anthropology, University of Alberta, Edmonton, Alberta Canada
| | - Adam Abba-Aji
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Alberta Health Services, Edmonton Zone, Edmonton, Alberta Canada
- Department of Psychiatry, University of Alberta, Edmonton, Alberta Canada
| | - Shirley Bighead
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Sturgeon Lake Health Centre, Sturgeon Lake First Nation, Saskatchewan, Canada
| | - Aileen MacKinnon
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Saqijuq Project, Nunavik, Québec Canada
| | - Ashok K. Malla
- Department of Psychiatry, McGill University, Montréal, Québec Canada
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, Québec Canada
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, Québec Canada
- Douglas Mental Health University Institute, Montréal, Québec Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec Canada
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Settipani CA, Hawke LD, Cleverley K, Chaim G, Cheung A, Mehra K, Rice M, Szatmari P, Henderson J. Key attributes of integrated community-based youth service hubs for mental health: a scoping review. Int J Ment Health Syst 2019; 13:52. [PMID: 31367230 PMCID: PMC6651922 DOI: 10.1186/s13033-019-0306-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 07/10/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Community-based, integrated youth service hubs have the potential to address some of the longstanding issues with mental health services for youth, including problems with access and system fragmentation. Better understanding of these approaches, particularly efforts to create a single point of entry to comprehensive, evidence-based services through youth service hubs, is needed to help guide future implementation and evaluation. This scoping review identifies the key principles and characteristics of these models of care, as well as the state of the literature, particularly with regard to implementation and replicability. METHOD Electronic databases and grey literature sources were searched for material from 2001 to 2019, with diverse search terms capturing the concept of "integrated" or "one-stop shop" youth mental health services. Title/abstract and full text review were conducted, as well as additional focused searching. After screening 4891 texts at the title/abstract level and 496 at the full-text level, 110 documents were included for data extraction. RESULTS Several integrated care hub models for youth mental health services and related frameworks were identified internationally, largely in high-income countries. Common principles included an emphasis on rapid access to care and early intervention, youth and family engagement, youth-friendly settings and services, evidence-informed approaches, and partnerships and collaboration. Program characteristics also revealed similarities (e.g., providing evidence-informed or evidence-based services in youth-friendly spaces), with some differences (e.g., care coordination methods, types of service providers), potentially attributable to lack of available information about key ingredients. Outcome research was limited, with few rigorous evaluations of youth outcomes. Moreover, sufficient information for replication, community evaluation of feasibility or actual implementation was rarely provided. CONCLUSION Internationally, integrated youth service hubs were found to share common key principles, while providing comprehensive services to youth with mental health difficulties. There is a great need for common language and measurement framework to facilitate replication, rigorous evaluation of outcomes, knowledge exchange, and dissemination of findings.
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Affiliation(s)
- Cara A. Settipani
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Lisa D. Hawke
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Kristin Cleverley
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON Canada
| | - Gloria Chaim
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Amy Cheung
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON Canada
| | - Kamna Mehra
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
| | | | - Peter Szatmari
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
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21
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Cairns AJ, Kavanagh DJ, Dark F, McPhail SM. Goal setting improves retention in youth mental health: a cross-sectional analysis. Child Adolesc Psychiatry Ment Health 2019; 13:31. [PMID: 31320924 PMCID: PMC6615268 DOI: 10.1186/s13034-019-0288-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study explored if a youth-specific mental health service routinely set goals with young people during initial intake/assessment and if goal setting and goal quality in this service was associated with patient retention. METHODS Consecutive initial assessments (n = 283) and administrative service data from two youth-specific health services in Australia were audited for evidence of goal setting, content and quality of the goal and number of therapy services provided after the intake/assessment process. Logistic regression was used to determine if goal setting was associated with disengagement after the assessment session, controlling for drug use, unemployment, age, gender, mental health diagnosis and service site. A consecutive sub-sample of 166 goals (74 participants), was analysed for goal quality. Each goal was assessed against three components of the SMART (specific, measurable, acceptable/achievable, realistic and timed goals) criteria; specific, measurable and timed; and assigned a goal quality score 1-3. A multiple regression explored whether goal quality was predictive of the number of sessions attended, controlling for the same variables as the logistic regression. RESULTS Goal setting was evident in the records of 187 participants (66%). Although most goals were for emotional management, 24% addressed improvements in function. Of the 166 goals analysed in depth, 95 were specific, 23 measurable, but none were timed. Not setting goals during initial assessments correlated with service disengagement (OR 0.30, p > 0.001). Goal setting was positively associated with more therapy sessions attended, regardless of goal quality rating. CONCLUSIONS Engagement and retention of young people within mental health services can be challenging. Clinical tools such as goal setting may keep young people engaged in services longer, potentially improving clinical outcomes. Further research exploring the effectiveness of current youth service models on client-specific goal based outcomes is recommended.
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Affiliation(s)
- Alice J. Cairns
- Centre for Rural and Remote Health, James Cook University, PO Box 341, Weipa, QLD 4874 Australia
| | - David J. Kavanagh
- Centre for Children’s Health Research, School of Psychology and Counselling and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Frances Dark
- Rehabilitation Academic Clinical Unit, Metro South Addiction and Mental Health Services, Metro South Health, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Steven M. McPhail
- Australian Centre for Health Services Innovation, School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
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22
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Malla A, Iyer S, Shah J, Joober R, Boksa P, Lal S, Fuhrer R, Andersson N, Abdel‐Baki A, Hutt‐MacLeod D, Beaton A, Reaume‐Zimmer P, Chisholm‐Nelson J, Rousseau C, Chandrasena R, Bourque J, Aubin D, Levasseur MA, Winkelmann I, Etter M, Kelland J, Tait C, Torrie J, Vallianatos H. Canadian response to need for transformation of youth mental health services: ACCESS Open Minds (Esprits ouverts). Early Interv Psychiatry 2019; 13:697-706. [PMID: 30556335 PMCID: PMC6563151 DOI: 10.1111/eip.12772] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 10/18/2018] [Accepted: 11/04/2018] [Indexed: 01/02/2023]
Abstract
AIM Youth mental health is of paramount significance to society globally. Given early onset of mental disorders and the inadequate access to appropriate services, a meaningful service transformation, based on globally recognized principles, is necessary. The aim of this paper is to describe a national Canadian project designed to achieve transformation of mental health services and to evaluate the impact of such transformation on individual and system related outcomes. METHOD We describe a model for transformation of services for youth with mental health and substance abuse problems across 14 geographically, linguistically and culturally diverse sites, including large and small urban, rural, First Nations and Inuit communities as well as homeless youth and a post-secondary educational setting. The principles guiding service transformation and objectives are identical across all sites but the method to achieve them varies depending on prevailing resources, culture, geography and the population to be served and how each community can best utilize the extra resources for transformation. RESULTS Each site is engaged in community mapping of services followed by training, active stakeholder engagement with youth and families, early case identification initiatives, providing rapid access (within 72 hours) to an assessment of the presenting problems, facilitating connection to an appropriate service within 30 days (if required) with no transition based on age within the 11 to 25 age group and a structured evaluation to track outcomes over the period of the study. CONCLUSIONS Service transformation that is likely to achieve substantial change involves very detailed and carefully orchestrated processes guided by a set of values, principles, clear objectives, training and evaluation. The evidence gathered from this project can form the basis for scaling up youth mental health services in Canada across a variety of environments.
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Affiliation(s)
- Ashok Malla
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Prevention and Early Intervention Program for Psychosis (PEPP)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Srividya Iyer
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Prevention and Early Intervention Program for Psychosis (PEPP)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Jai Shah
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Prevention and Early Intervention Program for Psychosis (PEPP)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Ridha Joober
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Prevention and Early Intervention Program for Psychosis (PEPP)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Patricia Boksa
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Shalini Lal
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Douglas Mental Health University InstituteMontréal, QuébecCanada
- School of Rehabilitation, Faculty of MedicineUniversité de MontréalMontréal, QuébecCanada
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM)Montréal, QuébecCanada
| | - Rebecca Fuhrer
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontréal, QuébecCanada
| | - Neil Andersson
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Department of Family Medicine, Community Information and Epidemiological Technologies (CIET) Institute and Participatory Research at McGill (PRAM)McGill UniversityMontréal, QuébecCanada
- McGill University Institute for Human Development and Well‐beingMontréal, QuébecCanada
| | - Amal Abdel‐Baki
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Department of PsychiatryUniversité de MontréalMontréal, QuébecCanada
- Centre hospitalier de l'Université de Montréal (CHUM), CRCHUMMontréal, QuébecCanada
| | - Daphne Hutt‐MacLeod
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Eskasoni Mental Health ServicesEskasoni, Nova ScotiaCanada
| | - Ann Beaton
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- School of Psychology, Faculty of Health Sciences and Community ServicesUniversité de MonctonMonctonNew BrunswickCanada
| | - Paula Reaume‐Zimmer
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Mental Health and Addictions ServicesBluewater Health and Canadian Mental Health AssociationLambton Kent, OntarioCanada
| | - Jessica Chisholm‐Nelson
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Cécile Rousseau
- Department of PsychiatryMcGill UniversityMontréal, QuébecCanada
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Centre de recherche SHERPA, Institut Universitaire au regard des communautés culturellesCentre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre‐Ouest‐de‐l'Île‐de‐MontréalMontréal, QuébecCanada
| | - Ranjith Chandrasena
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Schulich School of MedicineWestern UniversityLondonOntarioCanada
| | - Jimmy Bourque
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Faculty of EducationUniversité de MonctonMonctonNew BrunswickCanada
| | - Diane Aubin
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Dans La Rue and Réseau d'intervention de proximité auprès des jeunes de la rue (RIPAJ)‐Montréal/Homeless Youth NetworkMontréal, QuébecCanada
| | - Mary Anne Levasseur
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- ACCESS Open Minds Family and Carers Council, Douglas Mental Health University Institute, MontréalQuébecCanada
| | - Ina Winkelmann
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
| | - Meghan Etter
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Counselling ServicesInuvialuit Regional CorporationInuvik, Northwest TerritoriesCanada
| | - Jill Kelland
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Young Adult and Cross Level Services, Addiction and Mental Health, Edmonton Zone, Alberta Health ServicesEdmontonAlbertaCanada
| | - Caroline Tait
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Department of PsychiatryUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Jill Torrie
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Public Health DepartmentCree Board of Health and Social Services of James BayMistissini, QuébecCanada
| | - Helen Vallianatos
- ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network)Douglas Mental Health University InstituteMontréal, QuébecCanada
- Department of AnthropologyUniversity of AlbertaEdmontonAlbertaCanada
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Brownlie E, Beitchman JH, Chaim G, Wolfe DA, Rush B, Henderson J. Early Adolescent Substance Use and Mental Health Problems and Service Utilisation in a School-based Sample. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:116-125. [PMID: 29929386 PMCID: PMC6405806 DOI: 10.1177/0706743718784935] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This paper reports on substance use, mental health problems, and mental health service utilisation in an early adolescent school-based sample. METHOD Participants were 1,360 grade 7 and 8 students from 4 regions of Ontario, Canada. Students completed an in-class survey on mental health and substance use. The sampling strategy and survey items on demographics, substance use, service utilisation, and distress were adapted from the Ontario Student Drug Use and Health Survey. Internalising and externalising mental health problems were assessed using the Global Assessment of Individual Needs - Short Screener. Distress was defined as fair or poor self-rated mental health. RESULTS Rates of internalising and/or externalising problems above the threshold exceeded 30%; yet, fewer than half had received mental health services in the past 12 mo. Substance use was associated with increased odds of internalising and externalising problems above the threshold and distress. Youth using cannabis had 10-times the odds of exceeding the threshold for internalising or externalising problems. The use of substances other than alcohol or cannabis was associated with increased odds of fair or poor self-rated mental health among grade 8 students. Of the youth who confirmed at least a substance use problem, most also reported mental health problems; this association was stronger among girls than boys. CONCLUSIONS Early adolescent substance use was associated with concurrent self-reported mental health problems in a non-clinical sample. The low levels of service utilisation reported highlight the need for improved access to early identification and intervention to prevent the development of concurrent disorders.
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Affiliation(s)
- Elizabeth Brownlie
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Joseph H. Beitchman
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Gloria Chaim
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - David A. Wolfe
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Centre for Prevention Science, Centre for Addiction and Mental Health, Toronto, Ontario
- Centre for Research and Education on Violence against Women and Children at the Faculty of Education, Western University, London, Ontario
| | - Brian Rush
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
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Lawrence LM, Bishop A, Curran J. Integrated Knowledge Translation with Public Health Policy Makers: A Scoping Review. Healthc Policy 2019; 14:55-77. [PMID: 31017866 PMCID: PMC7008688 DOI: 10.12927/hcpol.2019.25792] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Integrated knowledge translation (iKT) refers to the engagement of knowledge users (e.g., policy makers, clinicians, patients) as active participants in the research process. Theoretically, this involvement enhances research relevancy and usefulness, thereby supporting health system change. However, evidence to support best practices for iKT is lacking, particularly in a public health context and with non-clinical decision-makers. The objectives of this research were to report how decision-maker involvement in public health iKT research has been described and operationalized and whether the process was evaluated. We conducted a scoping review of published literature from January 2005 to December 2017 and extracted information related to iKT involvement, barriers and facilitators and outcomes. Studies typically did not distinguish between different kinds of knowledge users, making it impossible to comment specifically on decision-makers' involvement. Authors believed knowledge user involvement was beneficial to the quality and potential impact of research activities, although corroborating evaluation data were unavailable. Broad research-knowledge user partnerships spanning multiple projects, as well as flexible involvement of knowledge users, enhanced engagement and supported the iKT process.
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Affiliation(s)
| | | | - Janet Curran
- Associate Professor, Dalhousie University, Halifax, NS
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McGorry PD, Mei C. Early intervention in youth mental health: progress and future directions. EVIDENCE-BASED MENTAL HEALTH 2018; 21:182-184. [PMID: 30352884 PMCID: PMC10270418 DOI: 10.1136/ebmental-2018-300060] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/25/2018] [Accepted: 09/29/2018] [Indexed: 11/03/2022]
Abstract
Early intervention is a fundamental principle in health care and the past two decades have seen it belatedly introduced into the field of mental health. This began in psychotic disorders, arguably the least promising place to start. The steady accumulation of scientific evidence for early intervention has eventually overwhelmed the sceptics, transformed thinking in psychotic disorders and created an international wave of service reform. This paradigm shift has paved the way to a more substantial one: early intervention across the full diagnostic spectrum. 75% of mental illnesses emerge before the age of 25 years, and young people bear the major burden for those disorders that threaten the many decades of productive adult life. The paradox is that young people aged between 12 and 25 years have had by far the worst levels of access to mental health care across the whole lifespan. Health services are poorly designed, grossly under-resourced and typically unfriendly to, and untrusted by, young people. Furthermore, until recently there has been a quite striking lack of interest in this transitional age group from clinicians and researchers alike, who had unthinkingly accepted the paediatric-adult split of mainstream medicine without questioning its utility and validity for our field and our young patients. Over the past decade, however, a major shift in momentum has occurred to take early intervention in youth mental health more seriously. Here we discuss the recent advances and evidence supporting an innovative integrated model of youth mental health care and look to the future.
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Affiliation(s)
- Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Cristina Mei
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
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Prior suicide attempts predict worse clinical and functional outcomes in young people attending a mental health service. J Affect Disord 2018; 238:563-569. [PMID: 29940520 DOI: 10.1016/j.jad.2018.06.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/07/2018] [Accepted: 06/12/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Mental disorders and suicidal thoughts and behaviours are common in help-seeking youth. Few studies report the longitudinal associations between these phenomena and clinical and functional outcomes. This study examined whether prior suicide attempts predict poorer outcomes in mental health service attendees. METHODS Clinical and functional data from 1143 individuals (aged 12-30) attending a primary care-based mental health service in Australia were collected over 3-60 months (median = 21 months). Odds ratios (OR) with 95% confidence intervals for the effect of a prior suicide attempt on follow-up outcomes were estimated (adjusted for confounders). RESULTS Prior suicide attempts were common (n = 164; 14%) and prospectively associated with suicidal thoughts (OR = 1.71), suicide attempts (OR = 2.59), self-harm (OR = 1.71), an increased likelihood of being diagnosed with bipolar disorder (OR = 2.99), and the onset of an alcohol/substance use disorder (OR = 2.87). Over the course of care, no suicide attempts were reported in 1052 (92%) individuals, but 25 (2%) had recurrent attempts, and 66 (6%) had new onset of an attempt. New onset was associated with being female and previous suicidal ideation or self-harm; recurrent attempts were associated with being older and comorbid alcohol/substance use disorder. LIMITATIONS The cohort includes only individuals who remained in clinical contact, and the consistency of their documentation varied (across clinicians and over time). CONCLUSIONS Young people with prior suicide attempts are vulnerable to ongoing suicidal behaviours, and poorer clinical and functional outcomes. More intensive management strategies may be needed to directly address these behaviours and the long-term risks they confer. These behaviours also emerge over the course of care among those with no previous history, which has important implications for active service-level strategies that target these behaviours for all of those who present to such services.
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MacDonald K, Fainman-Adelman N, Anderson KK, Iyer SN. Pathways to mental health services for young people: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2018; 53:1005-1038. [PMID: 30136192 PMCID: PMC6182505 DOI: 10.1007/s00127-018-1578-y] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/30/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE While early access to appropriate care can minimise the sequelae of mental illnesses, little is known about how youths come to access mental healthcare. We therefore conducted a systematic review to synthesise literature on the pathways to care of youths across a range of mental health problems. METHODS Studies were identified through searches of electronic databases (MEDLINE, PsycINFO, Embase, HealthSTAR and CINAHL), supplemented by backward and forward mapping and hand searching. We included studies on the pathways to mental healthcare of individuals aged 11-30 years. Two reviewers independently screened articles and extracted data. RESULTS Forty-five studies from 26 countries met eligibility criteria. The majority of these studies were from settings that offered services for the early stages of psychosis, and others included inpatient and outpatient settings targeting wide-ranging mental health problems. Generally, youths' pathways to mental healthcare were complex, involved diverse contacts, and, sometimes, undue treatment delays. Across contexts, family/carers, general practitioners and emergency rooms featured prominently in care pathways. There was little standardization in the measurement of pathways. CONCLUSIONS Except in psychosis, youths' pathways to mental healthcare remain understudied. Pathways to care research may need to be reconceptualised to account for the often transient and overlapping nature of youth mental health presentations, and the possibility that what constitutes optimal care may vary. Despite these complexities, additional research, using standardized methodology, can yield a greater understanding of the help-seeking behaviours of youths and those acting on their behalf; service responses to help-seeking; and the determinants of pathways. This understanding is critical to inform ongoing initatives to transform youth mental healthcare.
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Affiliation(s)
- Kathleen MacDonald
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds (pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Nina Fainman-Adelman
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds (pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, The University of Western Ontario, London, ON, Canada
- Department of Psychiatry, The University of Western Ontario, London, ON, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds (pan-Canadian youth mental health services research network), Douglas Mental Health University Institute, Montreal, QC, Canada.
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Baby or bathwater? Referrals of "non-cases" in a targeted early identification intervention for psychosis. Soc Psychiatry Psychiatr Epidemiol 2018. [PMID: 29541798 DOI: 10.1007/s00127-018-1502-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To explore the unintended impact of a targeted case identification (TCI) campaign for first episode psychosis (FEP) on people not experiencing FEP ("non-cases") with respect to referral patterns and reasons for being a non-case. METHODS Sources of referral, reasons for being a non-case, and subsequent referral destinations of non-cases were examined before and after a TCI. RESULTS Following the TCI, a greater proportion of non-cases lived outside the study catchment area. A smaller proportion was referred by the parent hospital's emergency room or had a substance-induced psychosis. CONCLUSIONS TCIs for FEP may have unintended effects, with implications for early case identification and early intervention services.
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Hetrick SE, Bailey AP, Smith KE, Malla A, Mathias S, Singh SP, O'Reilly A, Verma SK, Benoit L, Fleming TM, Moro MR, Rickwood DJ, Duffy J, Eriksen T, Illback R, Fisher CA, McGorry PD. Integrated (one-stop shop) youth health care: best available evidence and future directions. Med J Aust 2017; 207:S5-S18. [PMID: 29129182 DOI: 10.5694/mja17.00694] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/26/2017] [Indexed: 01/07/2023]
Abstract
Although mental health problems represent the largest burden of disease in young people, access to mental health care has been poor for this group. Integrated youth health care services have been proposed as an innovative solution. Integrated care joins up physical health, mental health and social care services, ideally in one location, so that a young person receives holistic care in a coordinated way. It can be implemented in a range of ways. A review of the available literature identified a range of studies reporting the results of evaluation research into integrated care services. The best available data indicate that many young people who may not otherwise have sought help are accessing these mental health services, and there are promising outcomes for most in terms of symptomatic and functional recovery. Where evaluated, young people report having benefited from and being highly satisfied with these services. Some young people, such as those with more severe presenting symptoms and those who received fewer treatment sessions, have failed to benefit, indicating a need for further integration with more specialist care. Efforts are underway to articulate the standards and core features to which integrated care services should adhere, as well as to further evaluate outcomes. This will guide the ongoing development of best practice models of service delivery.
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Affiliation(s)
- Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Alan P Bailey
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC
| | | | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Steve Mathias
- Foundry, Department of Psychiatry, University of British Columbia, and FRAYME/CADRE Knowledge Network, Vancouver, British Columbia, Canada
| | - Swaran P Singh
- Division of Health Sciences, University of Warwick, Coventry, UK
| | - Aileen O'Reilly
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland
| | - Swapna K Verma
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore, Singapore
| | - Laelia Benoit
- Sorbonne University and Maisons des Adolescents, Maison de Solenn, Cochin Hospital, Paris, France
| | - Theresa M Fleming
- Department of Psychological Medicine, University of Auckland, Auckland, and Te Wāhanga Tātai Hauora, Victoria University of Wellington, Wellington, New Zealand
| | - Marie Rose Moro
- Sorbonne University and Maisons des Adolescents, Maison de Solenn, Cochin Hospital, Paris, France
| | - Debra J Rickwood
- headspace, National Youth Mental Health Foundation, Melbourne, VIC
| | - Joseph Duffy
- Jigsaw, The National Centre for Youth Mental Health, Dublin, Ireland
| | - Trissel Eriksen
- Youth One Stop Shop, Network of Youth One Stop Shops, Palmerston North, New Zealand
| | | | - Caroline A Fisher
- Allied Health - Psychology, Royal Melbourne Hospital, Melbourne, VIC
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC
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MacKinnon N, Colman I. Factors Associated with Suicidal Thought and Help-Seeking Behaviour in Transition-Aged Youth versus Adults. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:789-796. [PMID: 27578771 PMCID: PMC5564895 DOI: 10.1177/0706743716667417] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Suicide is a leading cause of death for transition-aged youth (TAY), and yet few studies examine correlates of suicidal ideation specifically in this age demographic (age 18-24 years). The transition to adulthood is a unique context, marked by novel stressors (e.g., joining the workforce) and increased independence, which may influence risk factors for suicidal ideation. This study examined correlates of suicidal ideation in TAY and adults and contrasted profiles across age. METHODS We used 4 biannual cycles (2005, 2007, 2009, 2011) of the Canadian Community Health Survey, a population-based cross-sectional survey on health. We used logistic regression to assess the association between suicidal ideation and depression, distress, alcohol use, smoking, exercise, sedentary behaviour, chronic illness, restrictions to daily living, perceived physical and mental health, and perceived social support independently in both TAY ( n = 4427) and adults ( n = 14,452). We subsequently assessed possible interactions with age (18-24 v. 25-44 years) and sex and differences in help-seeking behaviour in a combined model. RESULT TAY exhibited higher rates of suicidal ideation than adults did ( P < 0.001). Numerous factors were associated with suicidal ideation in TAY. Notably, alcohol abstinence was associated with decreased suicidal ideation in TAY but not for adults. Moreover, when depressed, TAY were significantly less likely to have received professional mental health help than adults (odds ratio = 0.64, 95% CI, 0.43 to 0.94). CONCLUSIONS Suicidal ideation is more prevalent in TAY than adults, and its consequences may be aggravated by poor treatment-seeking behaviour in at-risk (i.e. depressed) individuals. These different risk profiles substantiate the recent shift toward clinical interventions focusing on transition-aged youth, rather than traditional child (<18 years) and adult (>18 years) services.
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Affiliation(s)
- Nathalie MacKinnon
- School of Epidemiology, Public Health & Preventive Medicine, University of Ottawa, Ottawa, Ontario
| | - Ian Colman
- School of Epidemiology, Public Health & Preventive Medicine, University of Ottawa, Ottawa, Ontario
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Malla A, Iyer S, McGorry P, Cannon M, Coughlan H, Singh S, Jones P, Joober R. From early intervention in psychosis to youth mental health reform: a review of the evolution and transformation of mental health services for young people. Soc Psychiatry Psychiatr Epidemiol 2016; 51:319-26. [PMID: 26687237 DOI: 10.1007/s00127-015-1165-4] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/29/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The objective of this review is to report on recent developments in youth mental health incorporating all levels of severity of mental disorders encouraged by progress in the field of early intervention in psychotic disorders, research in deficiencies in the current system and social advocacy. METHODS The authors have briefly reviewed the relevant current state of knowledge, challenges and the service and research response across four countries (Australia, Ireland, the UK and Canada) currently active in the youth mental health field. RESULTS Here we present information on response to principal challenges associated with improving youth mental services in each country. Australia has developed a model comprised of a distinct front-line youth mental health service (Headspace) to be implemented across the country and initially stimulated by success in early intervention in psychosis; in Ireland, Headstrong has been driven primarily through advocacy and philanthropy resulting in front-line services (Jigsaw) which are being implemented across different jurisdictions; in the UK, a limited regional response has addressed mostly problems with transition from child-adolescent to adult mental health services; and in Canada, a national multi-site research initiative involving transformation of youth mental health services has been launched with public and philanthropic funding, with the expectation that results of this study will inform implementation of a transformed model of service across the country including indigenous peoples. CONCLUSIONS There is evidence that several countries are now engaged in transformation of youth mental health services and in evaluation of these initiatives.
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Affiliation(s)
- Ashok Malla
- Department of Psychiatry, McGill University, Montreal, QC, Canada. .,ACCESS Open Minds Canada, Douglas Mental Health University Institute, Montreal, Canada. .,Douglas Hospital Research Centre, ACCESS Open Minds Pavilion, 6625 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada.
| | - Srividya Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,ACCESS Open Minds Canada, Douglas Mental Health University Institute, Montreal, Canada
| | | | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Swaran Singh
- Division of Mental Health, Warwick University, Coventry, England, UK
| | - Peter Jones
- Department of Psychiatry, Cambridge University, Cambridge, England, UK
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,ACCESS Open Minds Canada, Douglas Mental Health University Institute, Montreal, Canada
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Shah JL. Sub-threshold mental illness in adolescents: within and beyond DSM's boundaries. Soc Psychiatry Psychiatr Epidemiol 2015; 50:675-7. [PMID: 25660761 DOI: 10.1007/s00127-015-1015-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/27/2015] [Indexed: 01/01/2023]
Abstract
As researchers, clinicians and health systems strive to understand and improve mental health and well-being in youth, the parameters by which mental illness itself is defined have increasingly become the topic of inquiry. In the March 2015 issue of SPPE, Roberts et al. (Soc Psychiatry Psychiatr Epidemiol 50(3):397-406, 2015) integrate DSM diagnostic criteria with impairment in adolescents, showing that the latter is more frequent in full-syndrome disorders but still relevant for sub-threshold conditions, which have higher overall prevalence. These findings shift the focus away from specific diagnostic criteria and thresholds, and towards the backdrop of distress and impairment in young people. They also have implications for staging models and clinical services for youth mental health, particularly for prevention and early intervention efforts.
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Affiliation(s)
- Jai L Shah
- Prevention and Early Intervention Program for Psychoses (PEPP-Montréal), Douglas Mental Health University Institute, Montréal, Canada,
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