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van Doorn M, Monsanto A, Wang CL, Verfaillie SCJ, van Amelsvoort TAMJ, Popma A, Jaspers MWM, Öry F, Alvarez-Jimenez M, Gleeson JF, Nieman DH. The Effects of a Digital, Transdiagnostic, Clinically and Peer-Moderated Treatment Platform for Young People With Emerging Mental Health Complaints: Repeated Measures Within-Subjects Study. JMIR Mhealth Uhealth 2023; 11:e50636. [PMID: 38090802 PMCID: PMC10753424 DOI: 10.2196/50636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/19/2023] [Accepted: 10/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND To address the growing prevalence of youth mental health problems, early intervention is crucial to minimize individual, societal, and economic impacts. Indicative prevention aims to target emerging mental health complaints before the onset of a full-blown disorder. When intervening at this early stage, individuals are more responsive to treatment, resulting in cost-effective outcomes. The Moderated Online Social Therapy platform, which was successfully implemented and proven effective in Australia, is a digital, peer- and clinically moderated treatment platform designed for young people. The Netherlands was the first country outside Australia to implement this platform, under the name Engage Young People Early (ENYOY). It has the potential to reduce the likelihood of young people developing serious mental health disorders. OBJECTIVE This study aims to investigate the effects on young people using the ENYOY-platform in relation to psychological distress, psychosocial functioning, and positive health parameters. METHODS Dutch-speaking young people with emerging mental health complaints (N=131) participated in the ENYOY-platform for 6 months in a repeated measures within-subjects study. Psychological distress, psychosocial functioning, and positive health parameters were assessed at baseline and 3, 6, and 12 months. Repeated measures ANOVA was conducted and adjusted for age, sex, therapy, and community activity. The Reliable Change Index and Clinically Significant Index were computed to compare the baseline with the 6- and 12-month measurements. The missing data rate was 22.54% and the dropout rate 62.6% (82/131). RESULTS The primary analysis (77/131, 58.8%) showed that psychological distress decreased and psychosocial functioning improved over time with large effect sizes (P<.001 in both cases; ηp2=0.239 and 0.318, respectively) independent of age (P=.76 for psychological distress and P=.48 for psychosocial functioning), sex (P=.24 and P=.88, respectively), therapy activity (P=.49 and P=.80, respectively), or community activity (P=.59 and P=.48, respectively). Similarly, secondary analyses (51/131, 38.9%) showed significant effects of time on the quality of life, well-being, and meaningfulness positive health parameters (P<.05; ηp2=0.062, 0.140, and 0.121, respectively). Improvements in all outcome measures were found between baseline and 3 and 6 months (P≤.001-.01; d=0.23-0.62) and sustained at follow-up (P=.18-.97; d=0.01-0.16). The Reliable Change Index indicated psychological distress improvements in 38% (39/102) of cases, no change in 54.9% (56/102) of cases, and worsening in 5.9% (6/102) of cases. Regarding psychosocial functioning, the percentages were 50% (51/102), 43.1% (44/102), and 6.9% (7/102), respectively. The Clinically Significant Index demonstrated clinically significant changes in 75.5% (77/102) of cases for distress and 89.2% (91/102) for functioning. CONCLUSIONS This trial demonstrated that the ENYOY-platform holds promise as a transdiagnostic intervention for addressing emerging mental health complaints among young people in the Netherlands and laid the groundwork for further clinical research. It would be of great relevance to expand the population on and service delivery of the platform. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12888-021-03315-x.
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Affiliation(s)
- Marilon van Doorn
- Amsterdam University Medical Centers (Location AMC), Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Anne Monsanto
- Amsterdam University Medical Centers (Location AMC), Amsterdam, Netherlands
- Antes, Rotterdam, Netherlands
| | - Chen Lu Wang
- Amsterdam University Medical Centers (Location AMC), Amsterdam, Netherlands
| | - Sander C J Verfaillie
- Amsterdam University Medical Centers (Location AMC), Amsterdam, Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | | | - Arne Popma
- Amsterdam University Medical Centers (Location AMC), Amsterdam, Netherlands
| | - Monique W M Jaspers
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers (Location AMC), Amsterdam, Netherlands
| | | | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Orygen, Melbourne, Australia
| | - John F Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Dorien H Nieman
- Amsterdam University Medical Centers (Location AMC), Amsterdam, Netherlands
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Cross S, Nicholas J, Mangelsdorf S, Valentine L, Baker S, McGorry P, Gleeson J, Alvarez-Jimenez M. Developing a Theory of Change for a Digital Youth Mental Health Service (Moderated Online Social Therapy): Mixed Methods Knowledge Synthesis Study. JMIR Form Res 2023; 7:e49846. [PMID: 37921858 PMCID: PMC10656668 DOI: 10.2196/49846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/06/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Common challenges in the youth mental health system include low access, poor uptake, poor adherence, and limited overall effectiveness. Digital technologies offer promise, yet challenges in real-world integration and uptake persist. Moderated Online Social Therapy (MOST) aims to overcome these problems by integrating a comprehensive digital platform into existing youth mental health services. Theory of change (ToC) frameworks can help articulate how and why complex interventions work and what conditions are required for success. OBJECTIVE The objective of this study is to create a ToC for MOST to explain how it works, why it works, who benefits and how, and what conditions are required for its success. METHODS We used a multimethod approach to construct a ToC for MOST. The synthesis aimed to assess the real-world impact of MOST, a digital platform designed to enhance face-to-face youth mental health services, and to guide its iterative refinement. Data were gathered from 2 completed and 4 ongoing randomized controlled trials, 11 pilot studies, and over 1000 co-design sessions using MOST. Additionally, published qualitative findings from diverse clinical contexts and a review of related digital mental health literature were included. The study culminated in an updated ToC framework informed by expert feedback. The final ToC was produced in both narrative and table form and captured components common in program logic and ToC frameworks. RESULTS The MOST ToC captured several assumptions about digital mental health adoption, including factors such as the readiness of young people and service providers to embrace digital platforms. External considerations included high service demand and a potential lack of infrastructure to support integration. Young people and service providers face several challenges and pain points MOST seeks to address, such as limited accessibility, high demand, poor engagement, and a lack of personalized support. Self-determination theory, transdiagnostic psychological treatment approaches, and evidence-based implementation theories and their associated mechanisms are drawn upon to frame the intervention components that make up the platform. Platform usage data are captured and linked to short-, medium-, and long-term intended outcomes, such as reductions in mental health symptoms, improvements in functioning and quality of life, reductions in hospital visits, and reduced overall mental health care costs. CONCLUSIONS The MOST ToC serves as a strategic framework for refining MOST over time. The creation of the ToC helped guide the development of therapeutic content personalization, user engagement enhancement, and clinician adoption through specialized implementation frameworks. While powerful, the ToC approach has its limitations, such as a lack of standardized methodology and the amount of resourcing required for its development. Nonetheless, it provides an invaluable roadmap for iterative development, evaluation, and scaling of MOST and offers a replicable model for other digital health interventions aiming for targeted, evidence-based impact.
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Affiliation(s)
- Shane Cross
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Jennifer Nicholas
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Shaminka Mangelsdorf
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Lee Valentine
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | | | - Patrick McGorry
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - John Gleeson
- Healthy Brain and Mind Research Centre, Australian Catholic University, Melbourne, Australia
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Hickie IB, Iorfino F, Rohleder C, Song YJC, Nichles A, Zmicerevska N, Capon W, Guastella AJ, Leweke FM, Scott J, McGorry P, Mihalopoulos C, Killackey E, Chong MK, McKenna S, Aji M, Gorban C, Crouse JJ, Koethe D, Battisti R, Hamilton B, Lo A, Hackett ML, Hermens DF, Scott EM. EMPOWERED trial: protocol for a randomised control trial of digitally supported, highly personalised and measurement-based care to improve functional outcomes in young people with mood disorders. BMJ Open 2023; 13:e072082. [PMID: 37821139 PMCID: PMC10583041 DOI: 10.1136/bmjopen-2023-072082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/08/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES Many adolescents and young adults with emerging mood disorders do not achieve substantial improvements in education, employment, or social function after receiving standard youth mental health care. We have developed a new model of care referred to as 'highly personalised and measurement-based care' (HP&MBC). HP&MBC involves repeated assessment of multidimensional domains of morbidity to enable continuous and personalised clinical decision-making. Although measurement-based care is common in medical disease management, it is not a standard practice in mental health. This clinical effectiveness trial tests whether HP&MBC, supported by continuous digital feedback, delivers better functional improvements than standard care and digital support. METHOD AND ANALYSIS This controlled implementation trial is a PROBE study (Prospective, Randomised, Open, Blinded End-point) that comprises a multisite 24-month, assessor-blinded, follow-up study of 1500 individuals aged 15-25 years who present for mental health treatment. Eligible participants will be individually randomised (1:1) to 12 months of HP&MBC or standardised clinical care. The primary outcome measure is social and occupational functioning 12 months after trial entry, assessed by the Social and Occupational Functioning Assessment Scale. Clinical and social outcomes for all participants will be monitored for a further 12 months after cessation of active care. ETHICS AND DISSEMINATION This clinical trial has been reviewed and approved by the Human Research Ethics Committee of the Sydney Local Health District (HREC Approval Number: X22-0042 & 2022/ETH00725, Protocol ID: BMC-YMH-003-2018, protocol version: V.3, 03/08/2022). Research findings will be disseminated through peer-reviewed journals, presentations at scientific conferences, and to user and advocacy groups. Participant data will be deidentified. TRIAL REGISTRATION NUMBER ACTRN12622000882729.
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Affiliation(s)
- Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Cathrin Rohleder
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alissa Nichles
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Natalia Zmicerevska
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - William Capon
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adam J Guastella
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - F Markus Leweke
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine Mannheim, Psychiatry and Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Jan Scott
- Newcastle University, Newcastle upon Tyne, UK
| | - Patrick McGorry
- Centre for Youth Mental Health, University of Melbourne Australia, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne Australia, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Min K Chong
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah McKenna
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Melissa Aji
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Carla Gorban
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dagmar Koethe
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Blake Hamilton
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- headspace Camperdown, Camperdown, New South Wales, Australia
| | - Alice Lo
- Mind Plasticity, Sydney, New South Wales, Australia
| | - Maree L Hackett
- George Institute for Global Health, Newtown, New South Wales, Australia
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Chong MK, Hickie IB, Cross SP, McKenna S, Varidel M, Capon W, Davenport TA, LaMonica HM, Sawrikar V, Guastella A, Naismith SL, Scott EM, Iorfino F. Digital Application of Clinical Staging to Support Stratification in Youth Mental Health Services: Validity and Reliability Study. JMIR Form Res 2023; 7:e45161. [PMID: 37682588 PMCID: PMC10517388 DOI: 10.2196/45161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND As the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to individuals' risk of illness progression. The application of staging has been traditionally limited to trained clinicians yet leveraging digital technologies to apply clinical staging could increase the scalability and usability of this model in services. OBJECTIVE The aim of this study was to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders. METHODS We conducted a study with a cohort comprising 131 young people, aged between 16 and 25 years, who presented to youth mental health services in Australia between November 2018 and March 2021. Expert psychiatrists independently assigned clinical stages (either stage 1a or stage 1b+), which were then compared to the digital algorithm's allocation based on a multidimensional self-report questionnaire. RESULTS Of the 131 participants, the mean age was 20.3 (SD 2.4) years, and 72% (94/131) of them were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the experts' ratings, with a substantial interrater agreement (κ=0.67; P<.001). The algorithm demonstrated an accuracy of 91% (95% CI 86%-95%; P=.03), a sensitivity of 80%, a specificity of 93%, and an F1-score of 73%. Of the concordant ratings, 16 young people were allocated to stage 1a, while 103 were assigned to stage 1b+. Among the 12 discordant cases, the digital algorithm allocated a lower stage (stage 1a) to 8 participants compared to the experts. These individuals had significantly milder symptoms of depression (P<.001) and anxiety (P<.001) compared to those with concordant stage 1b+ ratings. CONCLUSIONS This novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in the early stages of common anxiety and depressive disorders. Between 11% and 27% of young people seeking care may benefit from low-intensity, self-directed, or brief interventions. Findings from this study suggest the possibility of redirecting clinical capacity to focus on individuals in stage 1b+ for further assessment and intervention.
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Affiliation(s)
- Min K Chong
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | | | - Sarah McKenna
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Mathew Varidel
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - William Capon
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Tracey A Davenport
- Design and Strategy Division, Australian Digital Health Agency, Sydney, Australia
| | - Haley M LaMonica
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Vilas Sawrikar
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Adam Guastella
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sharon L Naismith
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- Healthy Brain Ageing Program, University of Sydney, Sydney, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
- St Vincent's and Mater Clinical School, The University of Notre Dame, Sydney, Australia
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
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Karcher NR, Hicks R, Schiffman J, Asarnow JR, Calkins ME, Dauberman JL, Garrett CD, Koli RL, Larrauri CA, Loewy RL, McGough CA, Murphy JM, Niendam TA, Roaten K, Rodriguez J, Staglin BK, Wissow L, Woodberry KA, Young JF, Gur RE, Bearden CE, Barch DM. Youth Mental Health Screening and Linkage to Care. Psychiatr Serv 2023; 74:727-736. [PMID: 36695011 PMCID: PMC10329990 DOI: 10.1176/appi.ps.202200008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
One Mind, in partnership with Meadows Mental Health Policy Institute, convened several virtual meetings of mental health researchers, clinicians, and other stakeholders in 2020 to identify first steps toward creating an initiative for early screening and linkage to care for youths (individuals in early adolescence through early adulthood, ages 10-24 years) with mental health difficulties, including serious mental illness, in the United States. This article synthesizes and builds on discussions from those meetings by outlining and recommending potential steps and considerations for the development and integration of a novel measurement-based screening process in youth-facing school and medical settings to increase early identification of mental health needs and linkage to evidence-based care. Meeting attendees agreed on an initiative incorporating a staged assessment process that includes a first-stage brief screener for several domains of psychopathology. Individuals who meet threshold criteria on the first-stage screener would then complete an interview, a second-stage in-depth screening, or both. Screening must be followed by recommendations and linkage to an appropriate level of evidence-based care based on acuity of symptoms endorsed during the staged assessment. Meeting attendees proposed steps and discussed additional considerations for creating the first nationwide initiative for screening and linkage to care, an initiative that could transform access of youths to mental health screening and care.
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Affiliation(s)
- Nicole R. Karcher
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, MO
| | | | - Jason Schiffman
- Department of Psychological Science, University of California, Irvine, CA
| | - Joan R. Asarnow
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA
| | - Monica E. Calkins
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Judith L. Dauberman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Chantel D. Garrett
- Department of Health Services, Strong 365, University of Washington, Seattle, WA
| | - Roshni L. Koli
- Department of Psychiatry, University of Texas at Austin, Dell Medical School, Austin, TX, USA
| | | | - Rachel L. Loewy
- Department of Psychiatry, University of California, San Francisco, CA
| | | | - J. Michael Murphy
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Tara A. Niendam
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA
| | - Kimberly Roaten
- Department of Psychiatry, Meadows Mental Health Policy Institute, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jacqueline Rodriguez
- Student Support & Health Services, Sacramento City Unified School District, Sacramento, CA
| | | | - Lawrence Wissow
- Department of Psychiatry, University of Washington, Seattle, WA
| | - Kristen A. Woodberry
- Center for Psychiatric Research, Maine Medical Center Research Institute, Scarborough, ME
- Department of Psychiatry, Tufts School of Medicine, Boston, MA
| | - Jami F. Young
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, PA
| | - Raquel E. Gur
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, PA
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA
| | - Deanna M. Barch
- Department of Psychiatry, Washington University in St. Louis, School of Medicine, St. Louis, MO
- Departments of Psychological & Brain Sciences and Radiology, Washington University in St. Louis, St. Louis, MO
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Sawrikar V, Macbeth A, Gillespie-Smith K, Brown M, Lopez-Williams A, Boulton K, Guestella A, Hickie I. Transdiagnostic Clinical Staging for Childhood Mental Health: An Adjunctive Tool for Classifying Internalizing and Externalizing Syndromes that Emerge in Children Aged 5-11 Years. Clin Child Fam Psychol Rev 2022; 25:613-626. [PMID: 35598197 PMCID: PMC9427921 DOI: 10.1007/s10567-022-00399-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/20/2022]
Abstract
Clinical staging is now recognized as a key tool for facilitating innovation in personalized and preventative mental health care. It places a strong emphasis on the salience of indicated prevention, early intervention, and secondary prevention of major mental disorders. By contrast to established models for major mood and psychotic syndromes that emerge after puberty, developments in clinical staging for childhood-onset disorders lags significantly behind. In this article, criteria for a transdiagnostic staging model for those internalizing and externalizing disorders that emerge in childhood is presented. This sits alongside three putative pathophysiological profiles (developmental, circadian, and anxious-arousal) that may underpin these common illness trajectories. Given available evidence, we argue that it is now timely to develop a transdiagnostic staging model for childhood-onset syndromes. It is further argued that a transdiagnostic staging model has the potential to capture more precisely the dimensional, fluctuating developmental patterns of illness progression of childhood psychopathology. Given potential improvements in modelling etiological processes, and delivering more personalized interventions, transdiagnostic clinical staging for childhood holds much promise for assisting to improve outcomes. We finish by presenting an agenda for research in developments of transdiagnostic clinical staging for childhood mental health.
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Affiliation(s)
- Vilas Sawrikar
- Centre of Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK.
- Department of Clinical & Health Psychology, School of Health in Social Sciences, The University of Edinburgh, Medical School (Doorway 6), Room 1M.8, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Angus Macbeth
- Centre of Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK
- Department of Clinical & Health Psychology, School of Health in Social Sciences, The University of Edinburgh, Medical School (Doorway 6), Room 1M.8, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Karri Gillespie-Smith
- Centre of Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK
- Department of Clinical & Health Psychology, School of Health in Social Sciences, The University of Edinburgh, Medical School (Doorway 6), Room 1M.8, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Megan Brown
- ADHD & Autism Psychological Services and Advocacy, Utica, NY, USA
| | | | - Kelsie Boulton
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Adam Guestella
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Ian Hickie
- Brain and Mind Centre, University of Sydney, Sydney, Australia
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Hoter-Ishay G, Mashiach-Eizenberg M, Roe D. Young help-seeker profiles in Israel: The case of the first Israeli headspace centre. Early Interv Psychiatry 2022; 16:302-310. [PMID: 34342140 DOI: 10.1111/eip.13195] [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] [Received: 12/27/2020] [Revised: 04/08/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Abstract
AIM To describe clinical and demographic characteristics of youths who seek help at the first Headspace centre in Israel and their families. METHODS A sample of 291 (65%) of the youths (12- to 25-year-olds) who applied to Headspace between March 2016 and June 2018 completed an assessment, including reasons for referral and clinical status; the Kessler Psychological Distress Scale, evaluating psychological distress; and the Strengths and Difficulties Questionnaire, measuring emotional and behavioural difficulties. Their families reported burden of care via the Burden Assessment Scale. RESULTS Of the sample, 75% were between the ages of 12 and 17 years (equal gender distribution); for 45%, Headspace was their first encounter with mental health services. Participants' most-reported referral source was school counsellors (27%), and presenting concern (51%) was emotional problems, mainly depression (18%) and anxiety (16%). Female and older participants had more emotional difficulties than did males and younger participants, respectively. Overall, most help-seekers expressed high distress levels upon entry, and their family's burden was associated with those levels. CONCLUSIONS This first study of the first Headspace centre in Israel sheds light on and broadens knowledge about young help-seekers of Headspace outside of Australia. It emphasizes the trend across all ages of help-seeking youths with high psychological-distress levels and the role of family and school staff in the help-seeking process. Establishing youth services that improve access and deliver early intervention to a widely underserved population at times of high distress can be a global trajectory.
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Affiliation(s)
- Gili Hoter-Ishay
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Michal Mashiach-Eizenberg
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Jezreel Valley, Israel
| | - David Roe
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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Berry C, Hodgekins J, French P, Clarke T, Shepstone L, Barton G, Banerjee R, Byrne R, Fraser R, Grant K, Greenwood K, Notley C, Parker S, Wilson J, Yung AR, Fowler D. Clinical and cost-effectiveness of social recovery therapy for the prevention and treatment of long-term social disability among young people with emerging severe mental illness (PRODIGY): randomised controlled trial. Br J Psychiatry 2022; 220:154-162. [PMID: 35078555 PMCID: PMC7612415 DOI: 10.1192/bjp.2021.206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Young people with social disability and severe and complex mental health problems have poor outcomes, frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing care and providing targeted psychological or psychosocial intervention. AIMS We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would improve social recovery compared with ESC alone. METHOD A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was conducted in three UK centres. Participants (n = 270) were aged 16-25 years, with persistent social disability, defined as under 30 hours of structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured activity 15 months post-randomisation. RESULTS We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no significant difference between arms; treatment effect was -4.44 (95% CI -10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC alone arm. CONCLUSIONS We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes.
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Affiliation(s)
- Clio Berry
- School of Psychology, University of Sussex, Brighton and Hove, UK,Research & Development, Sussex Partnership NHS Foundation Trust, Brighton and Hove, UK,Primary Care and Public Health, Brighton and Sussex Medical School, Brighton and Hove, UK
| | - Joanne Hodgekins
- Norwich Medical School, University of East Anglia, Norwich, UK,Research & Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Paul French
- Manchester Metropolitan University, Faculty of Health, Psychology and Social Care, UK,Pennine Care Mental Health NHS Foundation Trust, Lancashire, UK
| | - Tim Clarke
- Research & Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Lee Shepstone
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Garry Barton
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Robin Banerjee
- School of Psychology, University of Sussex, Brighton and Hove, UK
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rick Fraser
- Research & Development, Sussex Partnership NHS Foundation Trust, Brighton and Hove, UK
| | - Kelly Grant
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Brighton and Hove, UK,Research & Development, Sussex Partnership NHS Foundation Trust, Brighton and Hove, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sophie Parker
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jon Wilson
- Research & Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Alison R Yung
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia,School of Health Sciences, University of Manchester, Manchester, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton and Hove, UK,Research & Development, Sussex Partnership NHS Foundation Trust, Brighton and Hove, UK
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9
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Iorfino F, Carpenter JS, Cross SP, Crouse J, Davenport TA, Hermens DF, Yee H, Nichles A, Zmicerevska N, Guastella A, Scott EM, Hickie IB. Social and occupational outcomes for young people who attend early intervention mental health services: a longitudinal study. Med J Aust 2021; 216:87-93. [PMID: 34664282 DOI: 10.5694/mja2.51308] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify trajectories of social and occupational functioning in young people during the two years after presenting for early intervention mental health care; to identify demographic and clinical factors that influence these trajectories. DESIGN Longitudinal, observational study of young people presenting for mental health care. SETTING Two primary care-based early intervention mental health services at the Brain and Mind Centre (University of Sydney), 1 June 2008 - 31 July 2018. PARTICIPANTS 1510 people aged 12-25 years who had presented with anxiety, mood, or psychotic disorders, for whom two years' follow-up data were available for analysis. MAIN OUTCOME MEASURES Latent class trajectories of social and occupational functioning based on growth mixture modelling of Social and Occupational Assessment Scale (SOFAS) scores. RESULTS We identified four trajectories of functioning during the first two years of care: deteriorating and volatile (733 participants, 49%); persistent impairment (237, 16%); stable good functioning (291, 19%); and improving, but late recurrence (249, 16%). The less favourable trajectories (deteriorating and volatile; persistent impairment) were associated with physical comorbidity, not being in education, employment, or training, having substance-related disorders, having been hospitalised, and having a childhood onset mental disorder, psychosis-like experiences, or a history of self-harm or suicidality. CONCLUSIONS Two in three young people with emerging mental disorders did not experience meaningful improvement in social and occupational functioning during two years of early intervention care. Most functional trajectories were also quite volatile, indicating the need for dynamic service models that emphasise multidisciplinary interventions and measurement-based care.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | | | - Shane Pm Cross
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | - Jacob Crouse
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | | | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD
| | - Hannah Yee
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | - Alissa Nichles
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | | | - Adam Guastella
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | | | - Ian B Hickie
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
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10
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Iorfino F, Cheng VWS, Cross SP, Yee HF, Davenport TA, Scott EM, Hickie IB. Right Care, First Time: Developing a Theory-Based Automated Protocol to Help Clinically Stage Young People Based on Severity and Persistence of Mental Illness. Front Public Health 2021; 9:621862. [PMID: 34513775 PMCID: PMC8429786 DOI: 10.3389/fpubh.2021.621862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 07/31/2021] [Indexed: 11/21/2022] Open
Abstract
Most mental disorders emerge before the age of 25 years and, if left untreated, have the potential to lead to considerable lifetime burden of disease. Many services struggle to manage high demand and have difficulty matching individuals to timely interventions due to the heterogeneity of disorders. The technological implementation of clinical staging for youth mental health may assist the early detection and treatment of mental disorders. We describe the development of a theory-based automated protocol to facilitate the initial clinical staging process, its intended use, and strategies for protocol validation and refinement. The automated clinical staging protocol leverages the clinical validation and evidence base of the staging model to improve its standardization, scalability, and utility by deploying it using Health Information Technologies (HIT). Its use has the potential to enhance clinical decision-making and transform existing care pathways, but further validation and evaluation of the tool in real-world settings is needed.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | | | - Shane P Cross
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Hannah F Yee
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | | | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
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11
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Dohnt HC, Dowling MJ, Davenport TA, Lee G, Cross SP, Scott EM, Song YJC, Hamilton B, Hockey SJ, Rohleder C, LaMonica HM, Hickie IB. Supporting Clinicians to Use Technology to Deliver Highly Personalized and Measurement-Based Mental Health Care to Young People: Protocol for an Evaluation Study. JMIR Res Protoc 2021; 10:e24697. [PMID: 34125074 PMCID: PMC8240796 DOI: 10.2196/24697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/22/2020] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Australia's mental health care system has long been fragmented and under-resourced, with services falling well short of demand. In response, the World Economic Forum has recently called for the rapid deployment of smarter, digitally enhanced health services to facilitate effective care coordination and address issues of demand. The University of Sydney's Brain and Mind Centre (BMC) has developed an innovative digital health solution that incorporates 2 components: a highly personalized and measurement-based (data-driven) model of youth mental health care and a health information technology (HIT) registered on the Australian Register of Therapeutic Goods. Importantly, research into implementation of such solutions considers education and training of clinicians to be essential to adoption and optimization of use in standard clinical practice. The BMC's Youth Mental Health and Technology Program has subsequently developed a comprehensive education and training program to accompany implementation of the digital health solution. OBJECTIVE This paper describes the protocol for an evaluation study to assess the effectiveness of the education and training program on the adoption and optimization of use of the digital health solution in service delivery. It also describes the proposed tools to assess the impact of training on knowledge and skills of mental health clinicians. METHODS The evaluation study will use the Kirkpatrick Evaluation Model as a framework with 4 levels of analysis: Reaction (to education and training), Learning (knowledge acquired), Behavior (practice change), and Results (client outcomes). Quantitative and qualitative data will be collected using a variety of tools, including evaluation forms, pre- and postknowledge questionnaires, skill development and behavior change scales, as well as a real-time clinical practice audit. RESULTS This project is funded by philanthropic funding from Future Generation Global. Ethics approval has been granted via Sydney Local Health District's Human Research Ethics Committee. At the time of this publication, clinicians and their services were being recruited to this study. The first results are expected to be submitted for publication in 2021. CONCLUSIONS The education and training program teaches clinicians the necessary knowledge and skills to assess, monitor, and manage complex needs; mood and psychotic syndromes; and trajectories of youth mental ill-health using a HIT that facilitates a highly personalized and measurement-based model of care. The digital health solution may therefore guide clinicians to help young people recover low functioning associated with subthreshold diagnostic presentations and prevent progression to more serious mental ill-health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/24697.
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Affiliation(s)
| | | | | | - Grace Lee
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Shane P Cross
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | | | - Yun Ju C Song
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Blake Hamilton
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Samuel J Hockey
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Cathrin Rohleder
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Haley M LaMonica
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
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12
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Sawrikar V, Stewart E, LaMonica HM, Iorfino F, Davenport TA, Cross S, Scott E, Naismith SL, Mowszowski L, Guastella A, Hickie IB. Using Staged Care to Provide "Right Care First Time" to People With Common Affective Disorders. Psychiatr Serv 2021; 72:691-703. [PMID: 33765863 DOI: 10.1176/appi.ps.202000145] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An ongoing need exists for innovation in service delivery to ensure that mental health services deliver high-quality treatment and prevention in the population. This Special Article proposes the adoption of "staged care" as a population health-oriented service delivery model for packages of specialized services delivered largely in ambulatory care settings for individuals with common affective disorders. Staged care integrates measures of clinical need alongside clinical stage and personal choice to select hierarchically arranged service packages for individuals. Packages then vary according to the intensity, duration, and mix of treatment options. This Special Article describes five levels of care in staged care: self- or family-directed monitoring and management, low-intensity services, moderate-intensity services, high-intensity services, and acute and specialist community mental health services. The care environment, treatment team, and length of treatment are also described, and provisional criteria are specified for assigning individuals to different care levels on the basis of current clinical need and clinical stage. Staged care is presented as a model that guides treatment selection and health service delivery to ensure that the high-quality care aims of "right care first time" and prevention are achieved and optimal use of available resources is considered.
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Affiliation(s)
- Vilas Sawrikar
- Brain and Mind Centre, University of Sydney, Sydney, Australia (Sawrikar, Stewart, LaMonica, Iorfino, Davenport, Cross, Naismith, Mowszowski, Guastella, Hickie); School of Health in Social Science, University of Edinburgh, Edinburgh (Sawrikar); School of Medicine, University of Notre Dame Australia, Sydney (Scott)
| | - Elizabeth Stewart
- Brain and Mind Centre, University of Sydney, Sydney, Australia (Sawrikar, Stewart, LaMonica, Iorfino, Davenport, Cross, Naismith, Mowszowski, Guastella, Hickie); School of Health in Social Science, University of Edinburgh, Edinburgh (Sawrikar); School of Medicine, University of Notre Dame Australia, Sydney (Scott)
| | - Haley M LaMonica
- Brain and Mind Centre, University of Sydney, Sydney, Australia (Sawrikar, Stewart, LaMonica, Iorfino, Davenport, Cross, Naismith, Mowszowski, Guastella, Hickie); School of Health in Social Science, University of Edinburgh, Edinburgh (Sawrikar); School of Medicine, University of Notre Dame Australia, Sydney (Scott)
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, Australia (Sawrikar, Stewart, LaMonica, Iorfino, Davenport, Cross, Naismith, Mowszowski, Guastella, Hickie); School of Health in Social Science, University of Edinburgh, Edinburgh (Sawrikar); School of Medicine, University of Notre Dame Australia, Sydney (Scott)
| | - Tracey A Davenport
- Brain and Mind Centre, University of Sydney, Sydney, Australia (Sawrikar, Stewart, LaMonica, Iorfino, Davenport, Cross, Naismith, Mowszowski, Guastella, Hickie); School of Health in Social Science, University of Edinburgh, Edinburgh (Sawrikar); School of Medicine, University of Notre Dame Australia, Sydney (Scott)
| | - Shane Cross
- Brain and Mind Centre, University of Sydney, Sydney, Australia (Sawrikar, Stewart, LaMonica, Iorfino, Davenport, Cross, Naismith, Mowszowski, Guastella, Hickie); School of Health in Social Science, University of Edinburgh, Edinburgh (Sawrikar); School of Medicine, University of Notre Dame Australia, Sydney (Scott)
| | - Elizabeth Scott
- Brain and Mind Centre, University of Sydney, Sydney, Australia (Sawrikar, Stewart, LaMonica, Iorfino, Davenport, Cross, Naismith, Mowszowski, Guastella, Hickie); School of Health in Social Science, University of Edinburgh, Edinburgh (Sawrikar); School of Medicine, University of Notre Dame Australia, Sydney (Scott)
| | - Sharon L Naismith
- Brain and Mind Centre, University of Sydney, Sydney, Australia (Sawrikar, Stewart, LaMonica, Iorfino, Davenport, Cross, Naismith, Mowszowski, Guastella, Hickie); School of Health in Social Science, University of Edinburgh, Edinburgh (Sawrikar); School of Medicine, University of Notre Dame Australia, Sydney (Scott)
| | - Loren Mowszowski
- Brain and Mind Centre, University of Sydney, Sydney, Australia (Sawrikar, Stewart, LaMonica, Iorfino, Davenport, Cross, Naismith, Mowszowski, Guastella, Hickie); School of Health in Social Science, University of Edinburgh, Edinburgh (Sawrikar); School of Medicine, University of Notre Dame Australia, Sydney (Scott)
| | - Adam Guastella
- Brain and Mind Centre, University of Sydney, Sydney, Australia (Sawrikar, Stewart, LaMonica, Iorfino, Davenport, Cross, Naismith, Mowszowski, Guastella, Hickie); School of Health in Social Science, University of Edinburgh, Edinburgh (Sawrikar); School of Medicine, University of Notre Dame Australia, Sydney (Scott)
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, Australia (Sawrikar, Stewart, LaMonica, Iorfino, Davenport, Cross, Naismith, Mowszowski, Guastella, Hickie); School of Health in Social Science, University of Edinburgh, Edinburgh (Sawrikar); School of Medicine, University of Notre Dame Australia, Sydney (Scott)
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13
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Le LKD, Shih S, Richards-Jones S, Chatterton ML, Engel L, Stevenson C, Lawrence D, Pepin G, Mihalopoulos C. The cost of Medicare-funded medical and pharmaceutical services for mental disorders in children and adolescents in Australia. PLoS One 2021; 16:e0249902. [PMID: 33836033 PMCID: PMC8034743 DOI: 10.1371/journal.pone.0249902] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/26/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine the health care costs associated with mental disorders and subthreshold mental disorders within a nationally representative sample of children and adolescents in Australia. METHOD Data were derived from the Young Minds Matter Survey (N = 6,310). Mental disorders were classified using the Diagnostic Interview Schedule for Children Version IV. Participant data were linked to administrative data on health care costs. Adjusted generalized linear regression models and two-part models were used to estimate mean differences in costs between those with a mental disorder or subthreshold disorder and those without. RESULTS Costs associated with health care attendances and medications were higher for children and adolescents with mental disorders and subthreshold mental disorders compared to those without a mental disorder. The additional population health care costs due to mental disorders amounted to AUD$234 million annually in children and adolescents, of which approximately 16% was attributed to out-of-pocket costs. Findings showed that those with subthreshold mental disorders or comorbid mental disorders have substantial additional costs of Medicare-funded medical and pharmaceutical services. CONCLUSION AND IMPLICATION Mental disorders in children and adolescents are associated with significant health care costs. Further research is needed to ensure that this population is receiving effective and efficient care.
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Affiliation(s)
- Long Khanh-Dao Le
- School of Health and Social Development, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
- * E-mail:
| | - Sophy Shih
- School of Health and Social Development, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Scott Richards-Jones
- School of Health and Social Development, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Mary Lou Chatterton
- School of Health and Social Development, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Lidia Engel
- School of Health and Social Development, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | | | - David Lawrence
- Graduate School of Education, The University of Western Australia, Perth, Australia
| | - Genevieve Pepin
- School of Health and Social Development, Deakin University, Geelong, Australia
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
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14
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Iorfino F, Piper SE, Prodan A, LaMonica HM, Davenport TA, Lee GY, Capon W, Scott EM, Occhipinti JA, Hickie IB. Using Digital Technologies to Facilitate Care Coordination Between Youth Mental Health Services: A Guide for Implementation. FRONTIERS IN HEALTH SERVICES 2021; 1:745456. [PMID: 36926493 PMCID: PMC10012639 DOI: 10.3389/frhs.2021.745456] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022]
Abstract
Enhanced care coordination is essential to improving access to and navigation between youth mental health services. By facilitating better communication and coordination within and between youth mental health services, the goal is to guide young people quickly to the level of care they need and reduce instances of those receiving inappropriate care (too much or too little), or no care at all. Yet, it is often unclear how this goal can be achieved in a scalable way in local regions. We recommend using technology-enabled care coordination to facilitate streamlined transitions for young people across primary, secondary, more specialised or hospital-based care. First, we describe how technology-enabled care coordination could be achieved through two fundamental shifts in current service provisions; a model of care which puts the person at the centre of their care; and a technology infrastructure that facilitates this model. Second, we detail how dynamic simulation modelling can be used to rapidly test the operational features of implementation and the likely impacts of technology-enabled care coordination in a local service environment. Combined with traditional implementation research, dynamic simulation modelling can facilitate the transformation of real-world services. This work demonstrates the benefits of creating a smart health service infrastructure with embedded dynamic simulation modelling to improve operational efficiency and clinical outcomes through participatory and data driven health service planning.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Sarah E Piper
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ante Prodan
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia.,School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Haley M LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | | | - Grace Yeeun Lee
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - William Capon
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
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15
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Romanowska S, MacQueen G, Goldstein BI, Wang J, Kennedy SH, Bray S, Lebel C, Addington J. Social and role functioning in youth at risk of serious mental illness. Early Interv Psychiatry 2020; 14:463-469. [PMID: 31502422 DOI: 10.1111/eip.12872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/20/2019] [Accepted: 08/25/2019] [Indexed: 01/02/2023]
Abstract
AIM Functional impairment is common in serious mental illness (SMI). This study assessed social and role functioning in a sample of youth at risk of SMI who met different stages of risk based on a transdiagnostic clinical staging model described by McGorry and colleagues. METHOD The sample consisted of 243 male and female youths aged 12-26 and included: non-help-seeking youth with risk factors (stage 0; n = 41); youth with mild symptoms (stage 1a; n = 52); youth with attenuated psychiatric syndromes (stage 1b; n = 108); and healthy controls (HCs; n = 42). Social and role functioning were assessed with the Global Functioning: Social and Role scales. RESULTS Participants in stage 1b (attenuated syndromes) had significantly poorer social and role functioning than stage 0 participants and HCs (P < .001) and poorer social functioning than stage 1a (P < .05). Stage 1a participants had significantly poorer social functioning than HCs (P < .01) and significantly poorer role functioning than stage 0 participants (P < .01). Participants in stages 1a and 1b did not significantly differ from each other in role functioning only. CONCLUSIONS This study demonstrates that mild to moderate functional impairments are present in young people experiencing subthreshold psychiatric symptoms and distress in the absence of a diagnosable mental illness. Results partially validate the model in that social although not role functioning declines across the stages.
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Affiliation(s)
- Sylvia Romanowska
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Glenda MacQueen
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Pharmacology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - JianLi Wang
- Work & Mental Health Research Unit, Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sidney H Kennedy
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada.,Arthur Sommer Rotenberg Chair in Suicide and Depression Studies, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Signe Bray
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Child & Adolescent Imaging Research (CAIR) Program, Calgary, Alberta, Canada
| | - Catherine Lebel
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Child & Adolescent Imaging Research (CAIR) Program, Calgary, Alberta, Canada
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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16
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Carpenter JS, Iorfino F, Cross S, Nichles A, Zmicerevska N, Crouse JJ, Palmer JR, Whitton AE, White D, Naismith SL, Guastella AJ, Hermens DF, Scott J, Scott EM, Hickie IB. Cohort profile: the Brain and Mind Centre Optymise cohort: tracking multidimensional outcomes in young people presenting for mental healthcare. BMJ Open 2020; 10:e030985. [PMID: 32229519 PMCID: PMC7170572 DOI: 10.1136/bmjopen-2019-030985] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The Brain and Mind Centre (BMC) Optymise cohort assesses multiple clinical and functional domains longitudinally in young people presenting for mental health care and treatment. Longitudinal tracking of this cohort will allow investigation of the relationships between multiple outcome domains across the course of care. Subsets of Optymise have completed detailed neuropsychological and neurobiological assessments, permitting investigation of associations between these measures and longitudinal course. PARTICIPANTS Young people (aged 12-30) presenting to clinics coordinated by the BMC were recruited to a research register (n=6743) progressively between June 2008 and July 2018. To date, 2767 individuals have been included in Optymise based on the availability of at least one detailed clinical assessment. MEASURES Trained researchers use a clinical research proforma to extract key data from clinical files to detail social and occupational functioning, clinical presentation, self-harm and suicidal thoughts and behaviours, alcohol and other substance use, physical health comorbidities, personal and family history of mental illness, and treatment utilisation at the following time points: baseline, 3, 6, 12, 24, 36, 48, and 60 months, and time last seen. FINDINGS TO DATE There is moderate to substantial agreement between raters for data collected via the proforma. While wide variations in individual illness course are clear, social and occupational outcomes suggest that the majority of cohort members show no improvement in functioning over time. Differential rates of longitudinal transition are reported between early and late stages of illness, with a number of baseline factors associated with these transitions. Furthermore, there are longitudinal associations between prior suicide attempts and inferior clinical and functional outcomes. FUTURE PLANS Future reports will detail the longitudinal course of each outcome domain and examine multidirectional relationships between these domains both cross-sectionally and longitudinally, and explore in subsets the associations between detailed neurobiological measures and clinical, social and functional outcomes.
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Affiliation(s)
- Joanne S Carpenter
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Frank Iorfino
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Shane Cross
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alissa Nichles
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Natalia Zmicerevska
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jacob J Crouse
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jake R Palmer
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Alexis E Whitton
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Django White
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sharon L Naismith
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adam J Guastella
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Daniel F Hermens
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Jan Scott
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Academic Psychiatry, Newcastle University, Newcastle, United Kingdom
- Diderot University, Sorbonne City, Paris, France
| | - Elizabeth M Scott
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Hickie IB, Scott EM, Cross SP, Iorfino F, Davenport TA, Guastella AJ, Naismith SL, Carpenter JS, Rohleder C, Crouse JJ, Hermens DF, Koethe D, Markus Leweke F, Tickell AM, Sawrikar V, Scott J. Right care, first time: a highly personalised and measurement-based care model to manage youth mental health. Med J Aust 2020; 211 Suppl 9:S3-S46. [PMID: 31679171 DOI: 10.5694/mja2.50383] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change. Consequently, the effects of adolescent-onset mood and psychotic syndromes can have long term consequences. A key clinical challenge for youth mental health is to develop and test new systems that align with current evidence for comorbid presentations and underlying neurobiology, and are useful for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. Our highly personalised and measurement-based care model includes three core concepts: ▶ A multidimensional assessment and outcomes framework that includes: social and occupational function; self-harm, suicidal thoughts and behaviour; alcohol or other substance misuse; physical health; and illness trajectory. ▶ Clinical stage. ▶ Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on proposed pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). The model explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within this highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care as well as utilisation of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality, mental health care for young people. CHAPTER 1: MULTIDIMENSIONAL OUTCOMES IN YOUTH MENTAL HEALTH CARE: WHAT MATTERS AND WHY?: Mood and psychotic syndromes present one of the most serious public health challenges that we face in the 21st century. Factors including prevalence, age of onset, and chronicity contribute to substantial burden and secondary risks such as alcohol or other substance misuse. Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change; thus, effects can have long term consequences. We propose five key domains which make up a multidimensional outcomes framework that aims to address the specific needs of young people presenting to health services with emerging mental illness. These include social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness type, stage and trajectory. Impairment and concurrent morbidity are well established in young people by the time they present for mental health care. Despite this, services and health professionals tend to focus on only one aspect of the presentation - illness type, stage and trajectory - and are often at odds with the preferences of young people and their families. There is a need to address the disconnect between mental health, physical health and social services and interventions, to ensure that youth mental health care focuses on the outcomes that matter to young people. CHAPTER 2: COMBINING CLINICAL STAGE AND PATHOPHYSIOLOGICAL MECHANISMS TO UNDERSTAND ILLNESS TRAJECTORIES IN YOUNG PEOPLE WITH EMERGING MOOD AND PSYCHOTIC SYNDROMES: Traditional diagnostic classification systems for mental disorders map poorly onto the early stages of illness experienced by young people, and purport categorical distinctions that are not readily supported by research into genetic, environmental and neurobiological risk factors. Consequently, a key clinical challenge in youth mental health is to develop and test new classification systems that align with current evidence on comorbid presentations, are consistent with current understanding of underlying neurobiology, and provide utility for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. This chapter outlines a transdiagnostic framework for classifying common adolescent-onset mood and psychotic syndromes, combining two independent but complementary dimensions: clinical staging, and three proposed pathophysiological mechanisms. Clinical staging reflects the progression of mental disorders and is in line with the concept used in general medicine, where more advanced stages are associated with a poorer prognosis and a need for more intensive interventions with a higher risk-to-benefit ratio. The three proposed pathophysiological mechanisms are neurodevelopmental abnormalities, hyperarousal and circadian dysfunction, which, over time, have illness trajectories (or pathways) to psychosis, anxious depression and bipolar spectrum disorders, respectively. The transdiagnostic framework has been evaluated in young people presenting to youth mental health clinics of the University of Sydney's Brain and Mind Centre, alongside a range of clinical and objective measures. Our research to date provides support for this framework, and we are now exploring its application to the development of more personalised models of care. CHAPTER 3: A COMPREHENSIVE ASSESSMENT FRAMEWORK FOR YOUTH MENTAL HEALTH: GUIDING HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE USING MULTIDIMENSIONAL AND OBJECTIVE MEASURES: There is an urgent need for improved care for young people with mental health problems, in particular those with subthreshold mental disorders that are not sufficiently severe to meet traditional diagnostic criteria. New comprehensive assessment frameworks are needed to capture the biopsychosocial profile of a young person to drive highly personalised and measurement-based mental health care. We present a range of multidimensional measures involving five key domains: social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness type, stage and trajectory. Objective measures include: neuropsychological function; sleep-wake behaviours and circadian rhythms; metabolic and immune markers; and brain structure and function. The recommended multidimensional measures facilitate the development of a comprehensive clinical picture. The objective measures help to further develop informative and novel insights into underlying pathophysiological mechanisms and illness trajectories to guide personalised care plans. A panel of specific multidimensional and objective measures are recommended as standard clinical practice, while others are recommended secondarily to provide deeper insights with the aim of revealing alternative clinical paths for targeted interventions and treatments matched to the clinical stage and proposed pathophysiological mechanisms of the young person. CHAPTER 4: PERSONALISING CARE OPTIONS IN YOUTH MENTAL HEALTH: USING MULTIDIMENSIONAL ASSESSMENT, CLINICAL STAGE, PATHOPHYSIOLOGICAL MECHANISMS, AND INDIVIDUAL ILLNESS TRAJECTORIES TO GUIDE TREATMENT SELECTION: New models of mental health care for young people require that interventions be matched to illness type, clinical stage, underlying pathophysiological mechanisms and individual illness trajectories. Narrow syndrome-focused classifications often direct clinical attention away from other key factors such as functional impairment, self-harm and suicidality, alcohol or other substance misuse, and poor physical health. By contrast, we outline a treatment selection guide for early intervention for adolescent-onset mood and psychotic syndromes (ie, active treatments and indicated and more specific secondary prevention strategies). This guide is based on experiences with the Brain and Mind Centre's highly personalised and measurement-based care model to manage youth mental health. The model incorporates three complementary core concepts: ▶A multidimensional assessment and outcomes framework including: social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness trajectory. ▶Clinical stage. ▶Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on three underlying pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). These core concepts are not mutually exclusive and together may facilitate improved outcomes through a clinical stage-appropriate and transdiagnostic framework that helps guide decisions regarding the provision of appropriate and effective care options. Given its emphasis on adolescent-onset mood and psychotic syndromes, the Brain and Mind Centre's model of care also respects a fundamental developmental perspective - categorising childhood problems (eg, anxiety and neurodevelopmental difficulties) as risk factors and respecting the fact that young people are in a period of major biological and social transition. Based on these factors, a range of social, psychological and pharmacological interventions are recommended, with an emphasis on balancing the personal benefit-to-cost ratio. CHAPTER 5: A SERVICE DELIVERY MODEL TO SUPPORT HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE IN YOUTH MENTAL HEALTH: Over the past decade, we have seen a growing focus on creating mental health service delivery models that better meet the unique needs of young Australians. Recent policy directives from the Australian Government recommend the adoption of stepped-care services to improve the appropriateness of care, determined by severity of need. Here, we propose that a highly personalised approach enhances stepped-care models by incorporating clinical staging and a young person's current and multidimensional needs. It explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within a highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care and use of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality of, mental health care for young people.
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Affiliation(s)
- Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,University of Notre Dame Australia, Sydney, NSW
| | - Shane P Cross
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | | | | | | | | | | | - Jacob J Crouse
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Daniel F Hermens
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, QLD
| | - Dagmar Koethe
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | | | | | - Vilas Sawrikar
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,University of Edinburgh, Edinburgh, UK
| | - Jan Scott
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
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Hickie IB, Davenport TA, Burns JM, Milton AC, Ospina-Pinillos L, Whittle L, Ricci CS, McLoughlin LT, Mendoza J, Cross SP, Piper SE, Iorfino F, LaMonica HM. Project Synergy: co-designing technology-enabled solutions for Australian mental health services reform. Med J Aust 2020; 211 Suppl 7:S3-S39. [PMID: 31587276 DOI: 10.5694/mja2.50349] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Project Synergy aims to test the potential of new and emerging technologies to enhance the quality of mental health care provided by traditional face-to-face services. Specifically, it seeks to ensure that consumers get the right care, first time (delivery of effective mental health care early in the course of illness). Using co-design with affected individuals, Project Synergy has built, implemented and evaluated an online platform to assist the assessment, feedback, management and monitoring of people with mental disorders. It also promotes the maintenance of wellbeing by collating health and social information from consumers, their supportive others and health professionals. This information is reported back openly to consumers and their service providers to promote genuine collaborative care. The online platform does not provide stand-alone medical or health advice, risk assessment, clinical diagnosis or treatment; instead, it supports users to decide what may be suitable care options. Using an iterative cycle of research and development, the first four studies of Project Synergy (2014-2016) involved the development of different types of online prototypes for young people (i) attending university; (ii) in three disadvantaged communities in New South Wales; (iii) at risk of suicide; and (iv) attending five headspace centres. These contributed valuable information concerning the co-design, build, user testing and evaluation of prototypes, as well as staff experiences during development and service quality improvements following implementation. Through ongoing research and development (2017-2020), these prototypes underpin one online platform that aims to support better multidimensional mental health outcomes for consumers; more efficient, effective and appropriate use of health professional knowledge and clinical skills; and quality improvements in mental health service delivery.
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Affiliation(s)
- Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | | | - Jane M Burns
- Swinburne Research, Swinburne University of Technology, Melbourne, VIC
| | | | - Laura Ospina-Pinillos
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,Department of Psychiatry and Mental Health, School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Lisa Whittle
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | | | - Larisa T McLoughlin
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, QLD
| | - John Mendoza
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,ConNetica, Caloundra, QLD
| | - Shane P Cross
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Sarah E Piper
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, NSW
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19
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Iorfino F, Scott EM, Carpenter JS, Cross SP, Hermens DF, Killedar M, Nichles A, Zmicerevska N, White D, Guastella AJ, Scott J, McGorry PD, Hickie IB. Clinical Stage Transitions in Persons Aged 12 to 25 Years Presenting to Early Intervention Mental Health Services With Anxiety, Mood, and Psychotic Disorders. JAMA Psychiatry 2019; 76:1167-1175. [PMID: 31461129 PMCID: PMC6714017 DOI: 10.1001/jamapsychiatry.2019.2360] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/03/2019] [Indexed: 12/16/2022]
Abstract
Importance The large contribution of psychiatric disorders to premature death and persistent disability among young people means that earlier identification and enhanced long-term care for those who are most at risk of developing life-threatening or chronic disorders is critical. Clinical staging as an adjunct to diagnosis to address emerging psychiatric disorders has been proposed for young people presenting for care; however, the longer-term utility of this system has not been established. Objectives To determine the rates of transition from earlier to later stages of anxiety, mood, psychotic, or comorbid disorders and to identify the demographic and clinical characteristics that are associated with the time course of these transitions. Design, Setting, and Participants A longitudinal, observational study of 2254 persons aged 12 to 25 years who obtained mental health care at 2 early intervention mental health services in Sydney, Australia, and were recruited to a research register between June 18, 2008, and July 24, 2018 (the Brain and Mind Centre Optymise Cohort). Main Outcomes and Measures The primary outcome of this study was transition from earlier to later clinical stages. A multistate Markov model was used to examine demographic (ie, age, sex, engagement in education, employment, or both) and clinical (ie, social and occupational function, clinical presentation, personal history of mental illness, physical health comorbidities, treatment use, self-harm, suicidal thoughts and behaviors) factors associated with these transitions. Results Of the 2254 individuals included in the study, mean (SD) age at baseline was 18.18 (3.33) years and 1330 (59.0%) were female. Data on race/ethnicity were not available. Median (interquartile range) follow-up was 14 (5-33) months. Of 685 participants at stage 1a (nonspecific symptoms), 253 (36.9%) transitioned to stage 1b (attenuated syndromes). Transition was associated with lower social functioning (hazard ratio [HR], 0.77; 95% CI, 0.66-0.90), engagement with education, employment, or both (HR, 0.47; 95% CI, 0.25-0.91), manic-like experiences (HR, 2.12; 95% CI, 1.19-3.78), psychotic-like experiences (HR, 2.13; 95% CI, 1.38-3.28), self-harm (HR, 1.42; 95% CI, 1.01-1.99), and older age (HR, 1.27; 95% CI, 1.11-1.45). Of 1370 stage 1b participants, 176 (12.8%) transitioned to stage 2 (full-threshold) disorders. Transition was associated with psychotic-like experiences (HR, 2.31; 95% CI, 1.65-3.23), circadian disturbance (HR, 1.66; 95% CI, 1.17-2.35), psychiatric medication (HR, 1.43; 95% CI, 1.03-1.99), childhood psychiatric disorder (HR, 1.62; 95% CI, 1.03-2.54), and older age (HR, 1.24; 95% CI, 1.05-1.45). Conclusions and Relevance Differential rates of progression from earlier to later stages of anxiety, mood, psychotic, or comorbid disorders were observed in young persons who presented for care at various stages. Understanding the rate and factors associated with transition assists planning of stage-specific clinical interventions and secondary prevention trials.
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Affiliation(s)
- Frank Iorfino
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Elizabeth M. Scott
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
- The University of Notre Dame, St Vincent’s and Mater Clinical School, Sydney, New South Wales, Australia
| | - Joanne S. Carpenter
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Shane P. Cross
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Daniel F. Hermens
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
- Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Madhura Killedar
- Sydney Informatics Hub, University of Sydney, New South Wales, Australia
| | - Alissa Nichles
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Natalia Zmicerevska
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Django White
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Adam J. Guastella
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, United Kingdom
| | - Patrick D. McGorry
- Orygen, National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Ian B. Hickie
- Youth Mental Health Team, Brain and Mind Centre, University of Sydney, New South Wales, Australia
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Schley C, Pace N, Mann R, McKenzie C, McRoberts A, Parker A. The headspace Brief Interventions Clinic: Increasing timely access to effective treatments for young people with early signs of mental health problems. Early Interv Psychiatry 2019; 13:1073-1082. [PMID: 30160372 DOI: 10.1111/eip.12729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 06/15/2018] [Accepted: 07/29/2018] [Indexed: 12/17/2022]
Abstract
AIM Timely access to treatment in the early stages of mental illness is pivotal to recovery and prevention of longer-term disablement. Yet, this can be challenging at times of growing service demands. The headspace Brief Interventions Clinic (BIC) is an innovative treatment model aiming to promote quick access to evidence-based interventions for young people presenting with early signs of mental disorders. METHODS The BIC treatment package comprises eight skill-building and behavioural intervention modules that young people can choose from. Treatment occurs over a maximum of six sessions with graduate students under supervision. Treatment outcomes are compared at baseline and final sessions, with client satisfaction measured at the final session. RESULTS Allocation to the BIC occurred within 2 to 3 weeks of initial referral. Most young people (73%) completed their treatment, attending on average four sessions. Significant reductions in overall psychological distress, depressive symptomatology and anxiety severity ratings were observed at completion of treatment, as well as significant improvements in social and occupational functioning. About 91% of young people stated that their outcome expectations had been entirely met and 95% were entirely satisfied with their treatment experience. A strong therapeutic relationship, specific strategies for managing emotions, coping and problem-solving and a choice of engaging in flexible and modularised content were identified as the most valued experiences by young people. CONCLUSION The BIC might be ideally suited for health care settings aiming to promote timely access to treatments for young people with early signs of mental disorders.
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Affiliation(s)
- Carsten Schley
- Orygen, The National Centre of Excellence in Youth Mental Health, headspace Sunshine Visy Cares Hub, Sunshine, Victoria, Australia
| | - Nicholas Pace
- Jesuit Social Services, Richmond, Victoria, Australia
| | - Rhianna Mann
- Orygen, The National Centre of Excellence in Youth Mental Health, headspace Glenroy, Glenroy, Victoria, Australia
| | - Catherine McKenzie
- Orygen, The National Centre of Excellence in Youth Mental Health headspace Werribee, Werribee, Victoria, Australia
| | - Alison McRoberts
- Orygen, The National Centre of Excellence in Youth Mental Health, headspace Glenroy, Glenroy, Victoria, Australia
| | - Alexandra Parker
- Victoria University, Institute for Health and Sport, Melbourne, Victoria, Australia
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Iorfino F, Cross SP, Davenport T, Carpenter JS, Scott E, Shiran S, Hickie IB. A Digital Platform Designed for Youth Mental Health Services to Deliver Personalized and Measurement-Based Care. Front Psychiatry 2019; 10:595. [PMID: 31507465 PMCID: PMC6716201 DOI: 10.3389/fpsyt.2019.00595] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 07/26/2019] [Indexed: 12/21/2022] Open
Abstract
Mental disorders that commonly emerge during adolescence and young adulthood are associated with substantial immediate burden and risks, as well as potentially imparting lifetime morbidity and premature mortality. While the development of health services that are youth focused and prioritize early intervention has been a critical step forward, an ongoing challenge is the heterogeneous nature of symptom profiles and illness trajectories. Consequently, it is often difficult to provide quality mental health care, at scale, that addresses the broad range of health, social, and functional needs of young people. Here, we describe a new digital platform designed to deliver personalized and measurement-based care. It provides health services and clinicians with the tools to directly address the multidimensional needs of young people. The term "personalized" describes the notion that the assessment of, and the sequence of interventions for, mental disorders are tailored to the young person-and their changing needs over time, while "measurement-based" describes the use of systematic and continuing assessment of a young person's outcomes over the entire course of clinical care. Together, these concepts support a framework for care that transcends a narrow focus on symptom reduction or risk reduction. Instead, it prioritizes a broader focus on enhancing social, health, and physical outcomes for young people and a commitment to tracking these outcomes throughout this key developmental period. Now, with twenty-first century technologies, it is possible to provide health services with the tools needed to deliver quality mental health care.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Research and development, Innowell, Pty Ltd., Sydney, NSW, Australia
| | - Shane P. Cross
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Tracey Davenport
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Research and development, Innowell, Pty Ltd., Sydney, NSW, Australia
| | | | - Elizabeth Scott
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Sagit Shiran
- Research and development, Innowell, Pty Ltd., Sydney, NSW, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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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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Smith R, Huo Y, Tassiopoulos K, Rutstein R, Kapetanovic S, Mellins C, Kacanek D, Malee K, Yogev R, Ann Sanders M, Malee K, Hunter S, Shearer W, Paul M, Cooper N, Harris L, Purswani M, Baig MM, Villegas A, Puga A, Navarro S, Garvie PA, Blood J, Burchett SK, Karthas N, Kammerer B, Wiznia A, Burey M, Shaw R, Auguste R, Dieudonne A, Bettica L, Johnson J, Chen JS, Bulkley MG, Ivey L, Grant M, Knapp K, Allison K, Wilkins M, Russell-Bell J, Acevedo-Flores M, Rios H, Olivera V, Silio M, Gabriel M, Sirois P, Spector SA, Norris K, Nichols S, McFarland E, Cagwin E, Barr E, Katai A, Scott G, Alvarez G, Fernandez G, Cuadra A. Mental Health Diagnoses, Symptoms, and Service Utilization in US Youth with Perinatal HIV Infection or HIV Exposure. AIDS Patient Care STDS 2019; 33:1-13. [PMID: 30601062 DOI: 10.1089/apc.2018.0096] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Youth perinatally HIV infected (PHIV) or HIV exposed, but uninfected (PHEU), are aging into adolescence and adulthood with multiple complex risk factors for mental health (MH) problems and poor MH treatment utilization. Our aims were to estimate prevalence of MH diagnoses, clinically significant symptoms, and MH treatment utilization among youth with PHIV and among PHEU youth, 10-22 years old. We also aimed to identify correlates of diagnoses and treatment utilization. Analyses of data from standardized interviews, behavioral assessments, and chart review of 551 youth revealed that 36% had a previous or current MH diagnosis, with no significant HIV status group differences. Prevalence of clinically significant symptoms was 15% for both groups, of whom a third had no diagnosis, and half were not receiving treatment. Among youth with a current MH diagnosis, those with PHIV had greater utilization of services than PHEU youth (67% vs. 51%; p = 0.04). Factors associated with MH diagnoses and/or treatment utilization included caregiver characteristics, age and sex of child, HIV status, and stressful life events. Prevalence of MH diagnoses was higher than in the general population, but lower than in similar perinatally HIV-exposed cohorts, with some unmet service needs, particularly in PHEU youth. Family characteristics warrant careful consideration in early diagnosis and treatment of MH problems among youth affected by HIV.
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Affiliation(s)
- Renee Smith
- Department of Pediatrics, University of Illinois at Chicago Children's Hospital, Chicago, Illinois
| | - Yanling Huo
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Katherine Tassiopoulos
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Richard Rutstein
- Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Suad Kapetanovic
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California
| | - Claude Mellins
- Department of Psychiatry and Sociomedical Sciences, Columbia University, New York, New York
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kathleen Malee
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Ospina-Pinillos L, Davenport T, Iorfino F, Tickell A, Cross S, Scott EM, Hickie IB. Using New and Innovative Technologies to Assess Clinical Stage in Early Intervention Youth Mental Health Services: Evaluation Study. J Med Internet Res 2018; 20:e259. [PMID: 30201602 PMCID: PMC6231849 DOI: 10.2196/jmir.9966] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 06/25/2018] [Accepted: 06/28/2018] [Indexed: 11/18/2022] Open
Abstract
Background Globally there is increasing recognition that new strategies are required to reduce disability due to common mental health problems. As 75% of mental health and substance use disorders emerge during the teenage or early adulthood years, these strategies need to be readily accessible to young people. When considering how to provide such services at scale, new and innovative technologies show promise in augmenting traditional clinic-based services. Objective The aim of this study was to test new and innovative technologies to assess clinical stage in early intervention youth mental health services using a prototypic online system known as the Mental Health eClinic (MHeC). Methods The online assessment within the MHeC was compared directly against traditional clinician assessment within 2 Sydney-based youth-specific mental health services (headspace Camperdown and headspace Campbelltown). A total of 204 young people were recruited to the study. Eligible participants completed both face-to-face and online assessments, which were randomly allocated and counterbalanced at a 1-to-3 ratio. These assessments were (1) a traditional 45- to 60-minute headspace face-to-face assessment performed by a Youth Access Clinician and (2) an approximate 60-minute online assessment (including a self-report Web-based survey, immediate dashboard of results, and a video visit with a clinician). All assessments were completed within a 2-week timeframe from initial presentation. Results Of the 72 participants who completed the study, 71% (51/72) were female and the mean age was 20.4 years (aged 16 to 25 years); 68% (49/72) of participants were recruited from headspace Camperdown and the remaining 32% (23/72) from headspace Campbelltown. Interrater agreement of participants’ stage, as determined after face-to-face assessment or online assessment, demonstrated fair agreement (kappa=.39, P<.001) with concordance in 68% of cases (49/72). Among the discordant cases, those who were allocated to a higher stage by online raters were more likely to report a past history of mental health disorders (P=.001), previous suicide planning (P=.002), and current cannabis misuse (P=.03) compared to those allocated to a lower stage. Conclusions The MHeC presents a new and innovative method for determining key clinical service parameters. It has the potential to be adapted to varied settings in which young people are connected with traditional clinical services and assist in providing the right care at the right time.
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Affiliation(s)
| | - Tracey Davenport
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Ashleigh Tickell
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Shane Cross
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | | | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Iorfino F, Hermens DF, Cross SPM, Zmicerevska N, Nichles A, Badcock CA, Groot J, Scott EM, Hickie IB. Delineating the trajectories of social and occupational functioning of young people attending early intervention mental health services in Australia: a longitudinal study. BMJ Open 2018; 8:e020678. [PMID: 29588325 PMCID: PMC5875606 DOI: 10.1136/bmjopen-2017-020678] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/06/2018] [Accepted: 02/16/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Mental disorders typically emerge during adolescence and young adulthood and put young people at risk for prolonged socioeconomic difficulties. This study describes the longitudinal course of social and occupational functioning of young people attending primary care-based, early intervention services. DESIGN A longitudinal study of young people receiving mental healthcare. SETTING Data were collected between January 2005 and August 2017 from a designated primary care-based mental health service. PARTICIPANTS 554 young people (54% women) aged 12-32 years. MEASURES A systematic medical file audit collected clinical and functional information at predetermined time intervals (ie, 3 months to 5+ years) using a clinical pro forma. Group-based trajectory modelling (GBTM) was used to identify distinct trajectories of social and occupational functioning over time (median number of observations per person=4; median follow-up time=23 months). RESULTS Between first clinical contact and time last seen, 15% of young people had reliably deteriorated, 23% improved and 62% did not demonstrate substantive change in function. Of the whole cohort, 69% had functional scores less than 70 at time last seen, indicative of ongoing and substantive impairment. GBTM identified six distinct functional trajectories whereby over 60% had moderate-to-serious functional impairment at entry and remained chronically impaired over time; 7% entered with serious impairment and deteriorated further; a quarter were mildly impaired at entry and functionally recovered and only a small minority (4%) presented with serious impairments and functionally improved over time. Not being in education, employment or training, previous hospitalisation and a younger age at baseline emerged as significant predictors of these functional trajectories. CONCLUSION Young people with emerging mental disorders have significant functional impairment at presentation for care, and for the majority, it persists over the course of clinical care. In addition to providing clinical care earlier in the course of illness, these data suggest that more sophisticated and more intensive individual-level and organisational strategies may be required to achieve significant and sustained functional improvements.
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Affiliation(s)
- Frank Iorfino
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel F Hermens
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| | - Shane, PM Cross
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Natalia Zmicerevska
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Alissa Nichles
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Caro-Anne Badcock
- Statistical Consulting, The University of Sydney, Sydney, New South Wales, Australia
| | - Josine Groot
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth M Scott
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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Hamilton MP, Hetrick SE, Mihalopoulos C, Baker D, Browne V, Chanen AM, Pennell K, Purcell R, Stavely H, McGorry PD. Targeting mental health care attributes by diagnosis and clinical stage: the views of youth mental health clinicians. Med J Aust 2017; 207:S19-S26. [PMID: 29129183 DOI: 10.5694/mja17.00692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/12/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To explore the potential utility of clinical stage and mental disorder categories as a basis for determining which attributes of youth mental health care should be offered to which groups of young people. METHODS In June 2017, we conducted an online survey of youth mental health clinicians that collected information on the participants' background and areas of expertise, then presented vignettes describing young people with different stages of six mental disorders (disorder-based vignettes were matched to participants' area of expertise). For each vignette, participants were asked to give a quantitative estimate of the proportion of young people with similar mental health problems they thought would clinically benefit from each of twelve attributes of mental health care (other than pharmacological or individual psychological therapies). Survey results were analysed as independent, disorder-based samples, using standard statistical tests of significance, and as a stratified sample using mixed-effects models. RESULTS A total of 412 clinicians working in 32 countries participated in both parts of the survey. Respondents represented a broad range of clinical disciplines, settings and areas of expertise. Their estimated proportions of young people who would benefit from the mental health care attributes varied by clinical stage and disorder (eg, a mean of 93% [interquartile range (IQR), 90%-100%] of young people with Stage 2 psychosis were estimated to benefit from case management with a multidisciplinary team; while only 15% [IQR, 1%-25%] of young people with Stage 1b generalised anxiety disorder were estimated to benefit from collection and processing of biological samples). Neither the background of the respondents nor the sex of the characters in the vignettes significantly influenced the results. CONCLUSION A combination of clinical stage and disorder information might be an appropriate basis for ensuring that the right attributes of early intervention mental health care are provided to the right young people at the right time. Policy and research priorities include trialling novel services, preferences research among young people, strengthening service responses to subthreshold disorders and promoting high-fidelity collection of clinical stage data in youth mental health settings.
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Affiliation(s)
- Matthew P Hamilton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | | | - David Baker
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Vivienne Browne
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Kerryn Pennell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Rosemary Purcell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Heather Stavely
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
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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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Cross SPM, Scott J, Hickie IB. Predicting early transition from sub-syndromal presentations to major mental disorders. BJPsych Open 2017; 3:223-227. [PMID: 28959452 PMCID: PMC5596309 DOI: 10.1192/bjpo.bp.117.004721] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/03/2017] [Accepted: 08/14/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Transition from at-risk state to full syndromal mental disorders is underexplored for unipolar and bipolar disorders compared with psychosis. AIMS Prospective, trans-diagnostic study of rates and predictors of early transition from sub-threshold to full syndromal mental disorder. METHOD One-year outcome of 243 consenting youth aged 15-25 years with a sub-syndromal presentation of a potentially severe mental disorder. Survival analysis and odds ratio (OR) for predictors of transition identified from baseline clinical and demographic ratings. RESULTS About 17% (n=36) experienced transition to a major mental disorder. Independent of syndromal diagnosis, transition was significantly more likely in individuals who were NEET (not in education, employment or training), in females and in those with more negative psychological symptoms (e.g. social withdrawal). CONCLUSIONS NEET status and negative symptoms are modifiable predictors of illness trajectory across diagnostic categories and are not specific to transition to psychosis. DECLARATION OF INTEREST I.B.H. has been a Commissioner in Australia's National Mental Health Commission since 2012. He was a board member of headspace: National Youth Mental Health Foundation until January 2012. He has led a range of community-based and pharmaceutical industry-supported depression awareness and education and training programmes. He has led projects for health professionals and the community supported by governmental, community agency and pharmaceutical industry partners (Wyeth, Eli Lilly, Servier, Pfizer, AstraZeneca) for the identification and management of depression and anxiety. He has received honoraria for presentations of his own work at educational seminars supported by a number of non-government organisations and the pharmaceutical industry (including Servier, Pfizer, AstraZeneca and Eli Lilly). He is a member of the Medical Advisory Panel for Medibank Private and also a board member of Psychosis Australia Trust. He leads an investigator-initiated study of the effects of agomelatine on circadian parameters (supported in part by Servier) and has participated in a multicentre clinical trial of the effects of agomelatine on sleep architecture in depression and a Servier-supported study of major depression and sleep disturbance in primary care settings. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Shane P M Cross
- , MPsych(Clinical), PhD, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Jan Scott
- , MBBS, MD, FRCPsych, Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Ian B Hickie
- , MD, MBBS, FRANZCP, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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Cross SPM, Hermens DF, Scott J, Salvador-Carulla L, Hickie IB. Differential impact of current diagnosis and clinical stage on attendance at a youth mental health service. Early Interv Psychiatry 2017; 11:255-262. [PMID: 26818811 DOI: 10.1111/eip.12319] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/15/2015] [Indexed: 11/26/2022]
Abstract
AIM To examine whether clinical stage of illness and current diagnosis influence appointment behaviour in a specialized primary-level youth mental health service. METHODS Factors associated with attendance at 8697 appointments made by 828 young people (females = 497) aged 12-25 years over a 1-year period were analysed. RESULTS The number of appointments made did not correlate with the rates of attendance. However, those with more severe psychiatric morbidity made significantly more appointments and missed significantly more appointments than those with less severe presentations. Impaired social functioning was the best predictor of female attendance rates, whereas age and clinical stage of illness best predicted male attendance rates. Current diagnosis rather than functional impairment appeared to influence the level of input offered by clinicians. CONCLUSIONS Age, gender, severity of illness, functioning and psychological distress had differential associations with both planned treatment intensity and attendance rates. These differences are likely to have implications for service provision in this youth population.
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Affiliation(s)
- Shane P M Cross
- Clinical Research Unit, University of Sydney, Camperdown, New South Wales, Australia
| | - Daniel F Hermens
- Clinical Research Unit, University of Sydney, Camperdown, New South Wales, Australia
| | - Jan Scott
- Department of Academic Psychiatry, Wolfson Unit, Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Luis Salvador-Carulla
- Mental Health Policy Unit, Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia.,Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Ian B Hickie
- Clinical Research Unit, University of Sydney, Camperdown, New South Wales, Australia
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Henderson JL, Cheung A, Cleverley K, Chaim G, Moretti ME, de Oliveira C, Hawke LD, Willan AR, O'Brien D, Heffernan O, Herzog T, Courey L, McDonald H, Grant E, Szatmari P. Integrated collaborative care teams to enhance service delivery to youth with mental health and substance use challenges: protocol for a pragmatic randomised controlled trial. BMJ Open 2017; 7:e014080. [PMID: 28167747 PMCID: PMC5293997 DOI: 10.1136/bmjopen-2016-014080] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/29/2016] [Accepted: 01/05/2017] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Among youth, the prevalence of mental health and addiction (MHA) disorders is roughly 20%, yet youth are challenged to access evidence-based services in a timely fashion. To address MHA system gaps, this study tests the benefits of an Integrated Collaborative Care Team (ICCT) model for youth with MHA challenges. A rapid, stepped-care approach geared to need in a youth-friendly environment is expected to result in better youth MHA outcomes. Moreover, the ICCT approach is expected to decrease service wait-times, be more youth-friendly and family-friendly, and be more cost-effective, providing substantial public health benefits. METHODS AND ANALYSIS In partnership with four community agencies, four adolescent psychiatry hospital departments, youth and family members with lived experience of MHA service use, and other stakeholders, we have developed an innovative model of collaborative, community-based service provision involving rapid access to needs-based MHA services. A total of 500 youth presenting for hospital-based, outpatient psychiatric service will be randomised to ICCT services or hospital-based treatment as usual, following a pragmatic randomised controlled trial design. The primary outcome variable will be the youth's functioning, assessed at intake, 6 months and 12 months. Secondary outcomes will include clinical change, youth/family satisfaction and perception of care, empowerment, engagement and the incremental cost-effectiveness ratio (ICER). Intent-to-treat analyses will be used on repeated-measures data, along with cost-effectiveness and cost-utility analyses, to determine intervention effectiveness. ETHICS AND DISSEMINATION Research Ethics Board approval has been received from the Centre for Addiction and Mental Health, as well as institutional ethical approval from participating community sites. This study will be conducted according to Good Clinical Practice guidelines. Participants will provide informed consent prior to study participation and data confidentiality will be ensured. A data safety monitoring panel will monitor the study. Results will be disseminated through community and peer-reviewed academic channels. TRIAL REGISTRATION NUMBER Clinicaltrials.gov NCT02836080.
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Affiliation(s)
| | - Amy Cheung
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kristin Cleverley
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Gloria Chaim
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Myla E Moretti
- Clinical Trials Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Lisa D Hawke
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Andrew R Willan
- SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - David O'Brien
- East Metro Youth Services, Scarborough, Ontario, Canada
| | - Olivia Heffernan
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Tyson Herzog
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Lynn Courey
- Sashbear Foundation, Toronto, Ontario, Canada
| | | | - Enid Grant
- Youth and Families, Toronto, Ontario, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
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Gehue LJ, Scott E, Hermens DF, Scott J, Hickie I. Youth Early-intervention Study (YES) - group interventions targeting social participation and physical well-being as an adjunct to treatment as usual: study protocol for a randomized controlled trial. Trials 2015; 16:333. [PMID: 26243349 PMCID: PMC4525721 DOI: 10.1186/s13063-015-0834-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 06/30/2015] [Indexed: 12/21/2022] Open
Abstract
Background It is increasingly acknowledged that clinical interventions for young persons with mental disorders need to optimize social, vocational and physical functioning, and take into account developmental needs, rather than focusing only on the traditional target of psychiatric symptom change. However, few interventions for youth presenting to mental health services offer a coherent rationale for multi-faceted approaches that efficiently address all these targets. This trial uses two facilitated group therapy modules (social and physical activity) as a vehicle for promoting clinical, cognitive, social and vocational change. The modules are an adjunct to usual treatments offered to youth attending mental health services in Sydney, Australia. Methods/Design The design is a 2-arm, parallel group cross-over, randomized clinical trial (RCT) that examines the efficacy of this adjunctive youth early intervention program (called “YES”) for improving social, vocational, mental and physical health functioning in a trans-diagnostic sample of 120 young persons aged 14–25 years who are currently receiving a range of “usual treatments” for clinically diagnosed anxiety, affective and/or psychotic disorders. Individuals who provide written informed consent are offered 2 group therapy modules (each comprising 4 hours per week for 8 weeks) with a 3-week “pause” between modules. Randomization determines whether individuals commence with module A or module B. The sample will be assessed pre-randomization, and at week 1 and week 8 (after completion of the first module), and at week 11 (commencement of second module) and week 19 (completion of second module). Final follow–up is 1-year post trial entry. Discussion If the findings of this exploratory trial demonstrate benefits in the target domains, then it will be important to extend the research by undertaking: (a) a comparison of the YES program to a control intervention in a randomized controlled trial, (b) an explanatory study of putative mediators of change, and (c) a multi-center trial with a number of trained therapists offering the group modules combined with a longer follow-up period. Trial registration Australian New Zealand Controlled Trial Registration: ACTRN1262400175673, Date: 16 July 2015
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Affiliation(s)
- Lillian Jean Gehue
- Clinical Research Unit, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia.
| | - Elizabeth Scott
- Clinical Research Unit, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia.
| | - Daniel Francis Hermens
- Clinical Research Unit, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia.
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
| | - Ian Hickie
- Clinical Research Unit, Brain and Mind Research Institute, The University of Sydney, Sydney, NSW, Australia.
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Hickie IB. Time to implement national mental health reform. Med J Aust 2015; 202:515-7. [PMID: 26021354 DOI: 10.5694/mja15.00490] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/01/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Ian B Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, NSW, Australia.
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Rickwood DJ, Mazzer KR, Telford NR, Parker AG, Tanti CJ, McGorry PD. Changes in psychological distress and psychosocial functioning in young people visiting headspace centres for mental health problems. Med J Aust 2015; 202:537-42. [DOI: 10.5694/mja14.01696] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/08/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Debra J Rickwood
- University of Canberra, Canberra, ACT
- headspace. The National Youth Mental Health Foundation, Melbourne, VIC
| | - Kelly R Mazzer
- headspace. The National Youth Mental Health Foundation, Melbourne, VIC
| | - Nic R Telford
- headspace. The National Youth Mental Health Foundation, Melbourne, VIC
| | | | - Chris J Tanti
- headspace. The National Youth Mental Health Foundation, Melbourne, VIC
| | - Patrick D McGorry
- Orygen Youth Health Research Centre, University of Melbourne, Melbourne, VIC
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Jureidini JN. Let children cry. Med J Aust 2015; 202:418. [PMID: 25929501 DOI: 10.5694/mja15.00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/03/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Jon N Jureidini
- Critical and Ethical Mental Health research group, University of Adelaide, Adelaide, SA, Australia.
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McGorry PD, Rickwood DJ, Hickie IB. Let children cry. Med J Aust 2015; 202:418. [PMID: 25929500 DOI: 10.5694/mja14.01681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/18/2015] [Indexed: 11/17/2022]
Affiliation(s)
| | - Debra J Rickwood
- headspace National Youth Mental Health Foundation, Melbourne, VIC, Australia
| | - Ian B Hickie
- Brain and Mind Research Institute, Sydney, NSW, Australia
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McGorry PD, Goldstone SD, Parker AG, Rickwood DJ, Hickie IB. Cultures for mental health care of young people: an Australian blueprint for reform. Lancet Psychiatry 2014; 1:559-68. [PMID: 26361315 DOI: 10.1016/s2215-0366(14)00082-0] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/06/2014] [Indexed: 11/30/2022]
Abstract
Mental ill health is now the most important health issue facing young people worldwide. It is the leading cause of disability in people aged 10-24 years, contributing 45% of the overall burden of disease in this age group. Despite their manifest need, young people have the lowest rates of access to mental health care, largely as a result of poor awareness and help-seeking, structural and cultural flaws within the existing care systems, and the failure of society to recognise the importance of this issue and invest in youth mental health. We outline the case for a specific youth mental health stream and describe the innovative service reforms in youth mental health in Australia, using them as an example of the processes that can guide the development and implementation of such a service stream. Early intervention with focus on the developmental period of greatest need and capacity to benefit, emerging adulthood, has the potential to greatly improve the mental health, wellbeing, productivity, and fulfilment of young people, and our wider society.
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Affiliation(s)
- Patrick D McGorry
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.
| | - Sherilyn D Goldstone
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Alexandra G Parker
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; Headspace National Youth Mental Health Foundation, Melbourne, VIC, Australia
| | - Debra J Rickwood
- Headspace National Youth Mental Health Foundation, Melbourne, VIC, Australia; Faculty of Health, University of Canberra, ACT, Australia
| | - Ian B Hickie
- Brain and Mind Research Centre, University of Sydney, NSW, Australia
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