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Dhandapani VR, Chandrasekaran S, Singh S, Sood M, Chadda RK, Shah J, Iyer S, Meyer C, Mohan M, Birchwood M, Madan J, Currie G, Ramachandran P, Rangaswamy T, Singh SP. Community stakeholders' perspectives on youth mental health in India: Problems, challenges and recommendations. Early Interv Psychiatry 2021; 15:716-722. [PMID: 32436369 DOI: 10.1111/eip.12984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/27/2020] [Accepted: 04/28/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND India has a large youth population whose mental health needs must be addressed. This includes promotion of positive mental health, with early detection and effective intervention for mental health disorders. Understanding the perspectives of community stakeholders working with youth is pivotal to this effort. Current study aimed to bring together a group of community stakeholders (eg, parents, teachers, policy makers) to understand their perspectives on youth mental health problems, challenges in provision of care, and to provide recommendations to address these concerns at national level. MATERIALS AND METHODS The study was conducted across two sites in India: Chennai and New Delhi. Three group meetings were conducted involving 52 participants, including governmental, non-governmental and community representatives working with youth. The proceedings were manually recorded, transcribed, and analyzed using thematic analysis method. RESULTS Many youth mental health problems were similar across the two sites. The commonest drivers of mental health problems were reported to be academic pressure, substance use and problematic internet/social media use. Stigma and lack of awareness were identified as the most important challenges acting as barriers to seeking mental health help by youth. Prioritizing youth mental health as a national programmes along with strong political will were the major recommendations suggested by the stakeholders. CONCLUSION Initial findings suggest that prioritizing youth mental health programmes in India would be advantageous. Inclusive and collaborative approach, involving community stakeholders working with youth in providing services that promote mental health and early access to care will help in developing healthy young citizens.
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Affiliation(s)
| | | | - Saurabh Singh
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh K Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Jai Shah
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Srividya Iyer
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Caroline Meyer
- WMG and Warwick Medical School, University of Warwick, Coventry, UK
| | - Mohapradeep Mohan
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Max Birchwood
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jason Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Graeme Currie
- Warwick Business School, University of Warwick, Coventry, UK
| | | | - Thara Rangaswamy
- Department of Psychiatry, Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - Swaran Preet Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
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Quinlan-Davidson M, Roberts KJ, Devakumar D, Sawyer SM, Cortez R, Kiss L. Evaluating quality in adolescent mental health services: a systematic review. BMJ Open 2021; 11:e044929. [PMID: 33972340 PMCID: PMC8112446 DOI: 10.1136/bmjopen-2020-044929] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/22/2021] [Accepted: 04/15/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To evaluate the quality of adolescent mental health service provision globally, according to the WHO Global Standards of adolescent mental health literacy, appropriate package of services and provider competencies. DESIGN AND DATA SOURCES Systematic review of 5 databases, and screening of eligible articles, from 1 January 2008 to 31 December 2020. STUDY ELIGIBILITY CRITERIA We focused on quantitative and mixed-method studies that evaluated adolescent mental health literacy, appropriate package of services and provider competencies in mental health services, and that targeted depression, anxiety and post-traumatic stress disorder among adolescents (10-19 years). This included adolescents exposed to interventions or strategies within mental health services. STUDY APPRAISAL AND SYNTHESIS METHODS Study quality was assessed using the National Institutes for Health Study Quality Assessment Tools. Data were extracted and grouped based on WHO quality Standards. RESULTS Of the 20 104 studies identified, 20 articles were included. The majority of studies came from high-income countries, with one from a low-income country. Most of the studies did not conceptualise quality. Results found that an online decision aid was evaluated to increase adolescent mental health literacy. Studies that targeted an appropriate package of services evaluated the quality of engagement between the therapist and adolescent, patient-centred communication, mental health service use, linkages to mental health services, health facility culture and intensive community treatment. Provider competencies focused on studies that evaluated confidence in managing and referring adolescents, collaboration between health facility levels, evidence-based practices and technology use. CONCLUSIONS AND IMPLICATIONS There is limited evidence on quality measures in adolescent mental health services (as conforms to the WHO Global Standards), pointing to a global evidence gap for adolescent mental health services. There are several challenges to overcome, including a need to develop consensus on quality and methods to measure quality in mental health settings. PROSPERO REGISTRATION NUMBER CRD42020161318.
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Affiliation(s)
| | | | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital; Murdoch Children's Research Institute; and Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Rafael Cortez
- Health, Nutrition and Population, The World Bank, Washington, District of Columbia, USA
| | - Ligia Kiss
- Institute for Global Health, University College London, London, UK
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Schraeder KE, Brown JB, Reid GJ. Perspectives on Monitoring Youth with Ongoing Mental Health Problems in Primary Health Care: Family Physicians Are "Out of the Loop". J Behav Health Serv Res 2019; 45:219-236. [PMID: 29260379 DOI: 10.1007/s11414-017-9577-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Children's mental health (CMH) problems often recur. Following specialized mental health treatment, youth may require monitoring and follow-up. For these youth, primary health care is highly relevant, as family physicians (FPs) are the only professionals who follow patients across the lifespan. The current study gained multiple perspectives about (1) the role of FPs in caring for youth with ongoing/recurring CMH problems and (2) incorporating routine mental health monitoring into primary health care. A total of 33 interviews were conducted, including 10 youth (aged 12-15) receiving CMH care, 10 parents, 10 CMH providers, and 3 FPs. Using grounded theory methodology, a theme of FPs being "out of the loop" or not involved in their patient's CMH care emerged. Families perceived a focus on the medical model by their FPs and believed FPs lacked mental health expertise. Findings indicate a need for improved collaboration between CMH providers and FPs in caring for youth with ongoing CMH problems.
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Affiliation(s)
- Kyleigh E Schraeder
- Department of Psychology, The University of Western Ontario, 361 Windermere Rd, Westminister Hall, Room 234E, London, ON, N6A 3K7, Canada.
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- School of Social Work, King's University College, London, ON, Canada
| | - Graham J Reid
- Department of Psychology, The University of Western Ontario, 361 Windermere Rd, Westminister Hall, Room 234E, London, ON, N6A 3K7, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Department of Paediatrics, The University of Western Ontario, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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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: 116] [Impact Index Per Article: 14.5] [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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Murphy A, Szumilas M, Rowe D, Landry K, Martin-Misener R, Kutcher S, Gardner D. Pharmacy students' experiences in provision of community pharmacy mental health services. Can Pharm J (Ott) 2014; 147:55-65. [PMID: 24494016 DOI: 10.1177/1715163513514170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little information is available describing the pharmacy student's experience working in community practice with people with lived experience of mental illness. Students' perspectives as observers, learners, technical staff and future pharmacists are important. OBJECTIVE To gain a better understanding of the pharmacy student experience in community pharmacy-based service provision to people with lived experience of mental illness. METHODS We conducted a qualitative study using interpretive description and application of the Theoretical Domains Framework. Focus groups were held with third- and fourth-year undergraduate pharmacy students from one Canadian university. RESULTS Two student focus groups were held in the fall of 2012 with 11 students (7 third year and 4 fourth year), 6 women and 5 men, mean age 24.5 (range, 21 to 30) years, averaging 3.2 years (range, 2 weeks to 7 years) of cumulative, mostly part-time, community pharmacy experience. Three broad themes emerged from the pharmacy student experience: (1) business tension; (2) roles, responsibilities and relationships; and (3) stigma. Students discussed their own roles, responsibilities and relationships in a pluralistic identity experience (i.e., pharmacy student, technician, future pharmacist). Application of the Theoretical Domains Framework demonstrated numerous influences on behaviour. CONCLUSIONS From the students' description of community pharmacy-based care of people with lived experience of mental illness, significant issues exist with current practices and behaviours. Advancing the role of pharmacists and pharmacy students to meet the needs of people with mental illness will require strategies to address multifactorial influences on behaviour.
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Affiliation(s)
- Andrea Murphy
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
| | - Magdalena Szumilas
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
| | - Denise Rowe
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
| | - Kathryn Landry
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
| | - Ruth Martin-Misener
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
| | - Stan Kutcher
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
| | - David Gardner
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
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Kutcher S, Wei Y. Challenges and Solutions in the Implementation of the School-Based Pathway to Care Model. CANADIAN JOURNAL OF SCHOOL PSYCHOLOGY 2013. [DOI: 10.1177/0829573512468859] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Most mental disorders often onset during the adolescent years, providing opportunities for educators, health care providers, and related stakeholders to work collaboratively in addressing adolescent mental health care needs. This report describes early implementations of various components of the School-Based Pathway to Care Model currently applied in Canada, identifies lessons learned, and suggests future directions. The School-Based Pathway to Care Model engages students, teachers, student service providers, parents/families, health care providers, and the wider community through various training programs and both formal and informal linkages between the school, community, and health providers. Preliminary evaluation of the model in whole and in part shows promising outcomes for its application in secondary schools within the wider framework of enhancing system capacity for addressing mental health needs of students. Future focus should be directed towards more rigorous research on the model and its various components.
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Affiliation(s)
- Stan Kutcher
- Dalhousie University and the IWK Health Center, Halifax, Nova Scotia, Canada
| | - Yifeng Wei
- Dalhousie University and the IWK Health Center, Halifax, Nova Scotia, Canada
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