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Powell T, Glozier N, Conn K, Einboden R, Buus N, Caldwell P, Milton A. The impact of early intervention psychosis services on hospitalisation experiences: a qualitative study with young people and their carers. BMC Psychiatry 2024; 24:350. [PMID: 38730333 PMCID: PMC11088060 DOI: 10.1186/s12888-024-05758-4] [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: 09/12/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND While a core aim of early intervention psychosis services (EIPS) is to prevent hospitalisation, many with a first episode of psychosis (FEP) will require inpatient care. We explored young people's (YP) and their carers' hospitalisation experiences prior to and during EIPS engagement and how factors across these services influenced these experiences. METHODS Using purposive sampling, we recruited twenty-seven YP, all of whom had been involved with the hospital system at some stage, and twelve support persons (parents and partners of YP) from state and federally funded EIPS in Australia with different models of care and integration with secondary mental health care. Audio-recorded interviews were conducted face-to-face or via phone. A diverse research team (including lived experience, clinician, and academic researchers) used an inductive thematic analysis process. RESULTS Four key themes were identified as influential in shaping participant's hospital experiences and provide ideas for an approach to care that is improved by the effective coordination of that care, and includes this care being delivered in a trauma informed manner: (1) A two-way street: EIPS affected how participants experienced hospitalisation, and vice versa; (2) It's about people: the quality and continuity of relationships participants had with staff, in hospital and at their EIPS, was central to their experience; (3) A gradual feeling of agency: participants viewed EIPS as both reducing involuntary care and supporting their self-management; and (4) Care coordination as navigation for the healthcare system: great when it works; frustrating when it breaks down. CONCLUSIONS Hospitalisation was viewed as a stressful and frequently traumatic event, but a approach to care founded on trust, transparency, and collaboration that is trauma-informed ameliorated this negative experience. Consistent EIPS care coordination was reported as essential in assisting YP and carers navigate the hospital system; conversely, discontinuity in EIPS staff and lack of integration of EIPS with hospital care undermined the positive impact of the EIPS care coordinator during hospitalisation. Care coordinator involvement as a facilitator, information provider, and collaborator in inpatient treatment decisions may improve the usefulness and meaningfulness of hospital interventions.
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Affiliation(s)
- Tacita Powell
- Adolescent Mental Health, Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Nicholas Glozier
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
- The University of Sydney and Australian Research Council (ARC) Centre of Excellence for, Camperdown, Australia
| | - Katrina Conn
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia
- Department of Education, NSW, Sydney, Australia
| | - Rochelle Einboden
- School of Nursing, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario (CHEO) & CHEO Research Institute, Ottawa, Canada
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
- School of Nursing, Western Sydney University, Camperdown, Australia
| | - Niels Buus
- School of Nursing and Midwifery, Monash University, Melbourne, Australia
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Patrick Caldwell
- School of Rural Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Alyssa Milton
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
- The University of Sydney and Australian Research Council (ARC) Centre of Excellence for, Camperdown, Australia.
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Jumper MBE, Friedman BR, Becker-Haimes EM, Dong F, Kohler CG, Hurford I, Calkins ME. Implementation of an Adapted Fidelity Scale for Pennsylvania Coordinated Specialty Care Programs for First Episode Psychosis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:421-435. [PMID: 37943446 DOI: 10.1007/s11121-023-01607-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/10/2023]
Abstract
Coordinated Specialty Care (CSC) is an evidence-based model for early intervention of first episode psychosis (FEP). Monitoring fidelity to CSC models is essential for proper evaluation of program outcomes and quality improvement. To address variability across CSC programs and fidelity assessment-associated burden, an adapted fidelity scale was developed and implemented statewide in Pennsylvania. This report describes the design and preliminary performance of the adapted scale. The Pennsylvania FEP Fidelity Scale (PA-FEP-FS) assesses adherence to the CSC model by focusing on essential model components of other established fidelity scales, in tandem with program evaluation data. Initial data from fourteen PA-FEP sites from 2018 to 2021 were examined as preliminary validation. Assessment-associated burdens and costs were also estimated. PA-FEP-FS captured essential components of CSC models and proved feasible for implementation across varying program structures, while minimizing burden and cost. Programs utilized annual feedback as CSC benchmarks, evidenced by increased scores over time. PA-FEP-FS provides a model for adapting CSC fidelity scales to meet state- or local-level requirements while reducing assessment burdens and costs that may be associated with existing scales.
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Affiliation(s)
- Megan B E Jumper
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Bess Rose Friedman
- Division of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Emily M Becker-Haimes
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Fanghong Dong
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Christian G Kohler
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Irene Hurford
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Monica E Calkins
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 10 Gates, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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D'Arcey JN, Zhao H, Wang W, Voineskos AN, Kozloff N, Kidd SA, Foussias G. An SMS text messaging intervention to improve clinical engagement in early psychosis: A pilot randomized-controlled trial. Schizophr Res 2024; 264:416-423. [PMID: 38241785 DOI: 10.1016/j.schres.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 12/19/2023] [Accepted: 01/01/2024] [Indexed: 01/21/2024]
Abstract
Disengagement of youth with psychosis from Early Psychosis Intervention (EPI) services continues to be a significant barrier to recovery, with approximately one-third prematurely discontinuing treatment despite the ongoing need. The current pilot trial sought to evaluate the preliminary efficacy and feasibility of a weekly short message service (SMS) intervention to improve engagement in EPI services. This was a longitudinal single-blinded randomized control trial in which participants were assigned to receive either an active or sham SMS intervention over nine months. Sixty-one participants with early psychosis between the ages of 16 and 29 were enrolled, randomized, and received at least part of the intervention. Primary outcomes consisted of participant clinic attendance rates over the course of the intervention and clinician-rated engagement. Secondary measures included patient-rated therapeutic rapport, attitude toward medication, psychopathology, cognition, functioning, and intervention feedback from participants. Compared to the sham group, participants receiving the active intervention did not show improved appointment attendance rates; however, did exhibit some improvements in aspects of engagement, including improved clinician-rated availability, attitude toward medication, positive symptoms, avolition-apathy and social functioning. Thus, contrary to our hypotheses, digitally augmented care did not result in enhanced engagement in EPI services, as measured by clinic attendance, although with some indication that it may contribute to improved attitude toward medication and, potentially, medication adherence. Weekly SMS text messaging appeared to result in a pattern of engagement whereby individuals who were improving clinically attended appointments less often, possibly due to inadvertent use of the intervention to check in with clinicians. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04379349).
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Affiliation(s)
- Jessica N D'Arcey
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Canada
| | - Haoyu Zhao
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, Canada
| | - Wei Wang
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, Canada; College of Public Health, University of South Florida, United States of America
| | - Aristotle N Voineskos
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Canada; Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Nicole Kozloff
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Sean A Kidd
- Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
| | - George Foussias
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Canada; Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada.
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Milton A, Powell T, Conn K, Einboden R, Buus N, Glozier N. Experiences of service transitions in Australian early intervention psychosis services: a qualitative study with young people and their supporters. BMC Psychiatry 2022; 22:788. [PMID: 36514052 PMCID: PMC9749227 DOI: 10.1186/s12888-022-04413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 10/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Different Early Intervention Psychosis Service (EIPS) models of care exist, but many rely upon community-based specialist clinical teams, often with other services providing psychosocial care. Time-limited EIPS care creates numerous service transitions that have potential to interrupt continuity of care. We explored with young people (YP) and their support people (SP) their experiences of these transitions, how they affected care and how they could be better managed. METHODS Using purposive sampling, we recruited twenty-seven YP, all of whom had been hospitalised at some stage, and twelve SP (parents and partners of YP) from state and federally funded EIPS in Australia with different models of care and integration into secondary mental health care. Audio-recorded interviews were conducted face-to-face or via phone. A diverse research team (including lived experience, clinician and academic researchers) used an inductive thematic analysis process. Two researchers undertook iterative coding using NVivo12 software, themes were developed and refined in ongoing team discussion. RESULTS The analysis identified four major service-related transitions in a YP's journey with the EIPS that were described as reflecting critical moments of care, including: transitioning into EIPS; within service changes; transitioning in and out of hospital whilst in EIPS care; and, EIPS discharge. These service-related transition affected continuity of care, whilst within service changes, such as staff turnover, affected the consistency of care and could result in information asymmetry. At these transition points, continuity of care, ensuring service accessibility and flexibility, person centredness and undertake bio-psychosocial support and planning were recommended. State and federally funded services both had high levels of service satisfaction, however, there was evidence of higher staff turnover in federally funded services. CONCLUSION Service transitions were identified as vulnerable times in YP and SP continuity of care. Although these were often well supported by the EIPS, participants provided illustrative examples for service improvement. These included enhancing continuity and consistency of care, through informed and supportive handovers when staff changes occur, and collaborative planning with other services and the YP, particularly during critical change periods such as hospitalisation.
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Affiliation(s)
- Alyssa Milton
- Sydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, NSW, 2050, Camperdown, Australia. .,The University of Sydney and Australian Research Council (ARC) Centre of Excellence for Children and Families over the Life Course, Sydney, Australia.
| | - Tacita Powell
- Adolescent Court and Community Team Justice Health and Forensic Mental Health Network, Sydney, Australia
| | - Katrina Conn
- grid.1013.30000 0004 1936 834XSydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, NSW 2050 Camperdown, Australia ,grid.461941.f0000 0001 0703 8464NSW Department of Education, Sydney, Australia
| | - Rochelle Einboden
- grid.28046.380000 0001 2182 2255Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada ,grid.1013.30000 0004 1936 834XSusan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Niels Buus
- grid.1002.30000 0004 1936 7857School of Nursing and Midwifery, Monash University, Clayton, Australia ,grid.10825.3e0000 0001 0728 0170Department Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Nicholas Glozier
- grid.1013.30000 0004 1936 834XSydney School of Medicine (Central Clinical School), Faculty of Medicine and Health, University of Sydney, 94 Mallett Street, NSW 2050 Camperdown, Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney and Australian Research Council (ARC) Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
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Fusion of Clinical and Lived Experiences of Psychosis: Lessons Learned and Implications for Future Clinical Teaching. PSYCHIATRY INTERNATIONAL 2022. [DOI: 10.3390/psychiatryint3040023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Psychosis is a clinical syndrome that can cause significant distress leading to hospitalisation/long term stays in psychiatric services. However, limited academic evidence is available examining the lived experience of psychosis. Additionally, no evidence is available looking to combine both learned and experiential knowledge as it pertains to psychosis. As such this article was created to combine both knowledge subsets in order to provide a more complete interpretation of the syndrome itself. This was achieved through academic input from a psychiatrist’s perspective as well as a reflective, autoethnographic input from a service user who has experienced psychosis. Following this collaboration, several recommendations were made to support health professionals to engage appropriately with service users with psychosis. However, the lived experiences of psychosis itself requires further investigation to identify commonalities in experiences that can support clinicians in the diagnosis and co-production of treatment regimens for these service users.
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6
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Bertulies-Esposito B, Iyer S, Abdel-Baki A. The Impact of Policy Changes, Dedicated Funding and Implementation Support on Early Intervention Programs for Psychosis. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:585-597. [PMID: 35014891 PMCID: PMC9301149 DOI: 10.1177/07067437211065726] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Early intervention services for psychosis (EIS) are associated with improved clinical and economic outcomes. In Quebec, clinicians led the development of EIS from the late 1980s until 2017 when the provincial government announced EIS-specific funding, implementation support and provincial standards. This provides an interesting context to understand the impacts of policy commitments on EIS. Our primary objective was to describe the implementation of EIS three years after this increased political involvement. METHODS This cross-sectional descriptive study was conducted in 2020 through a 161-question online survey, modeled after our team's earlier surveys, on the following themes: program characteristics, accessibility, program operations, clinical services, training/supervision, and quality assurance. Descriptive statistics were performed. When relevant, we compared data on programs founded before and after 2017. RESULTS Twenty-eight of 33 existing EIS completed the survey. Between 2016 and 2020, the proportion of Quebec's population having access to EIS rose from 46% to 88%; >1,300 yearly admissions were reported by surveyed EIS, surpassing governments' epidemiological estimates. Most programs set accessibility targets; adopted inclusive intake criteria and an open referral policy; engaged in education of referral sources. A wide range of biopsychosocial interventions and assertive outreach were offered by interdisciplinary teams. Administrative/organisational components were less widely implemented, such as clinical/administrative data collection, respecting recommended patient-to-case manager ratios and quality assurance. CONCLUSION Increased governmental implementation support including dedicated funding led to widespread implementation of good-quality, accessible EIS. Though some differences were found between programs founded before and after 2017, there was no overall discernible impact of year of implementation. Persisting challenges to collecting data may impede monitoring, data-informed decision-making, and quality improvement. Maintaining fidelity and meeting provincial standards may prove challenging as programs mature and adapt to their catchment area's specificities and as caseloads increase. Governmental incidence estimates may need recalculation considering recent epidemiological data.
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Affiliation(s)
- Bastian Bertulies-Esposito
- Department of Psychiatry and Addictology, 5622Université de Montréal, Montreal, Canada.,Quebec Integrated University Centre for Health and Social Services of Centre-Sud-de-l'Ile-de-Montreal, Montreal, Canada.,177460Centre de recherche du CHUM, Montreal, Canada
| | - Srividya Iyer
- Department of Psychiatry, 5620McGill University, Montreal, Canada.,Montréal West Island Integrated University Health and Social Services Centre, Douglas Hospital Research Centre & Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Montreal, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry and Addictology, 5622Université de Montréal, Montreal, Canada.,177460Centre de recherche du CHUM, Montreal, Canada.,Clinique JAP (Early Intervention for Psychosis Clinic) and the Youth Mental Health Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
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White C, Nash L, Karageorge A, van der Pol R, Hunt GE, Hamilton B, Isobel S. Bridging the gap: A new integrated early intervention service for young people with complex mental health issues. Early Interv Psychiatry 2022; 16:186-194. [PMID: 33949103 DOI: 10.1111/eip.13152] [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] [Received: 12/24/2020] [Revised: 03/17/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
Abstract
AIM Two integrated headspace Early Intervention Teams (hEITs) were established in 2017 to bridge gaps between headspace, the national primary care youth mental health programme in Australia, and the state funded secondary and tertiary mental health services. This study aims to describe functioning and outcomes of patients referred to hEIT over a 6-month period. METHODS A retrospective file audit was conducted for all patients accepted into the service over a 6-month period in 2018. Measures of distress, functioning and client satisfaction were collected and analysed. Exemplar vignettes were created to construct hypothetical examples and illustrate research findings. RESULTS At admission, the three most common presentations were depression/anxiety, trauma and stress related, and psychotic disorders. During their time in the service, young people displayed a statistically significant improvement in functioning, reduction in self-harm in those 18 years and under, and a trend to reduction in distress scores. hEIT delivered a broad range of services covering social, occupational, educational, medical and mental health care, and the service was experienced positively by the patient cohort. CONCLUSIONS hEIT appears to meet the needs of young people requiring greater care than primary care services can deliver. The integrated, wrap-around care coordination facilitates treatments across social, educational and health domains. Further exploration of young people who disengage from care, improved outcome data reporting and economic evaluation are indicated.
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Affiliation(s)
| | - Louise Nash
- Sydney Local Health District, Sydney, Australia.,Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Aspasia Karageorge
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Glenn E Hunt
- Sydney Local Health District, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Sophie Isobel
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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McGorry PD, Mei C, Chanen A, Hodges C, Alvarez-Jimenez M, Killackey E. Designing and scaling up integrated youth mental health care. World Psychiatry 2022; 21:61-76. [PMID: 35015367 PMCID: PMC8751571 DOI: 10.1002/wps.20938] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mental ill-health represents the main threat to the health, survival and future potential of young people around the world. There are indications that this is a rising tide of vulnerability and need for care, a trend that has been augmented by the COVID-19 pandemic. It represents a global public health crisis, which not only demands a deep and sophisticated understanding of possible targets for prevention, but also urgent reform and investment in the provision of developmentally appropriate clinical care. Despite having the greatest level of need, and potential to benefit, adolescents and emerging adults have the worst access to timely and quality mental health care. How is this global crisis to be addressed? Since the start of the century, a range of co-designed youth mental health strategies and innovations have emerged. These range from digital platforms, through to new models of primary care to new services for potentially severe mental illness, which must be locally adapted according to the availability of resources, workforce, cultural factors and health financing patterns. The fulcrum of this progress is the advent of broad-spectrum, integrated primary youth mental health care services. They represent a blueprint and beach-head for an overdue global system reform. While resources will vary across settings, the mental health needs of young people are largely universal, and underpin a set of fundamental principles and design features. These include establishing an accessible, "soft entry" youth primary care platform with digital support, where young people are valued and essential partners in the design, operation, management and evaluation of the service. Global progress achieved to date in implementing integrated youth mental health care has highlighted that these services are being accessed by young people with genuine and substantial mental health needs, that they are benefiting from them, and that both these young people and their families are highly satisfied with the services they receive. However, we are still at base camp and these primary care platforms need to be scaled up across the globe, complemented by prevention, digital platforms and, crucially, more specialized care for complex and persistent conditions, aligned to this transitional age range (from approximately 12 to 25 years). The rising tide of mental ill-health in young people globally demands that this focus be elevated to a top priority in global health.
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Affiliation(s)
- Patrick D McGorry
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Cristina Mei
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Andrew Chanen
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Craig Hodges
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Eóin Killackey
- Orygen, National Centre of Excellence in Youth Mental Health; Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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Siebert S, Leopold K, Baumgardt J, von Hardenberg LS, Burkhardt E, Bechdolf A. Specialized inpatient treatment for young people with early psychosis: acute-treatment and 12-month results. Eur Arch Psychiatry Clin Neurosci 2022; 272:1-14. [PMID: 35141809 PMCID: PMC9508217 DOI: 10.1007/s00406-022-01379-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 01/09/2022] [Indexed: 01/02/2023]
Abstract
The objective of the study was to investigate the development of clinical outcomes of young people with early psychosis in a specialized inpatient treatment and assess the feasibility of such an intervention in an inpatient setting. The study was a prospective cohort study of patients with early psychosis treated at the specialized inpatient treatment "Fühinterventions-und Therapiezentrum, FRITZ" (early intervention and therapy center) in Berlin, Germany. The primary outcomes were attitudes towards psychiatric medication and patient satisfaction with treatment after 6 weeks. Secondary outcomes were clinical symptoms, functioning, remission, recovery, all-cause treatment discontinuation, and rehospitalisation at 6 and 12 months after inpatient treatment. We recruited 95 inpatients with early psychosis. Attitudes towards psychiatric medication (Δ6weeks = 3.00, d6weeks = 0.55; Δ6mo = 2.15, d6mo = 0.35; Δ12mo = 3.03, d12mo = 0.52) and patient satisfaction (Δ6weeks = 0.21, d6weeks = 0.40; Δ6mo = 0.32, d6mo = 0.43; Δ12mo = 0.13, d12mo = 0.17) changed with medium effect sizes at six weeks up to a 6- and 12-month follow-up. Clinical outcomes changed significantly with medium-to-large-effect sizes over 12 months CGIΔ12mo = 1.64, d12mo = -1.12; PANSS totalΔ12mo = 20.10, d12mo = -0.76; GAFΔ12mo = 19.58, d12mo = 1.25). The all-cause treatment discontinuation rate was 13.69% (n = 13) at a 6-month and 35.79% (n = 34) at a 12-month follow-up. The rehospitalization rate was 30.53% (n = 29) at a 6-month and 43.16% (n = 41) at a 12-month follow-up. Patients with specialized inpatient treatment for early psychosis showed improvements in attitude towards psychiatric medication, patient satisfaction, symptoms, and functioning for up to 12 months.Trial registration: DRKS00024351, 2021/02/11 retrospectively registered.
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Affiliation(s)
- Stefan Siebert
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating FRITZ and soulspace, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Charité-Universitätsmedizin, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - Karolina Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating FRITZ and soulspace, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Charité-Universitätsmedizin, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - Johanna Baumgardt
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating FRITZ and soulspace, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Charité-Universitätsmedizin, Dieffenbachstraße 1, 10967, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Laura-Sophie von Hardenberg
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating FRITZ and soulspace, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Charité-Universitätsmedizin, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - Eva Burkhardt
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating FRITZ and soulspace, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Charité-Universitätsmedizin, Dieffenbachstraße 1, 10967, Berlin, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating FRITZ and soulspace, Vivantes Hospital Am Urban and Vivantes Hospital Im Friedrichshain, Charité-Universitätsmedizin, Dieffenbachstraße 1, 10967, Berlin, Germany.
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, Cologne, Germany.
- Orygen, Parkville, VIC, Australia.
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10
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Selby P, Vojtila L, Ashfaq I, Dragonetti R, Melamed OC, Carriere R, LaChance L, Kohut SA, Hahn M, Mulsant BH. Technology-enabled collaborative care for youth with early psychosis: A protocol for a feasibility study to improve physical health behaviours. Early Interv Psychiatry 2021; 15:828-836. [PMID: 32748501 DOI: 10.1111/eip.13018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/29/2020] [Accepted: 06/24/2020] [Indexed: 12/22/2022]
Abstract
AIM Individuals with psychotic disorders have poorer health outcomes and die earlier due to cardiovascular diseases when compared to healthy populations. Contributing factors include low levels of physical activity, poor nutrition and tobacco smoking. Currently, patients navigate a fragmented health-care system to seek physical and mental health services, often without access to evidence-based health promotion interventions, especially in non-academic settings or rural areas, increasing client barriers at the individual and provider level. To address these gaps, we wish to test the feasibility and impact of a Technology-Enabled Collaborative Care for Youth (TECC-Y) model to improve healthy behaviours among youth with early psychosis. The model addresses geographical barriers and maldistribution of physical and mental health care. METHODS A randomized controlled trial, including youth (ages of 16-29) with early psychosis (diagnosed in the past 5 years) residing in Ontario, Canada. Our primary outcome is client engagement. Secondary outcomes include smoking status, physical health and nutrition. Participants are randomly assigned to either a health coach supervised by a virtual care team, or a self-directed learning group (e-platform with psychoeducational materials). Assessments are conducted at baseline, 6, 12 and 24 weeks. RESULTS This paper presents the protocol of the study. Recruitment commenced in August 2018. This study was registered on 16 July 2018 on clinicaltrials.gov (Registry ID: NCT03610087). CONCLUSIONS TECC-Y will determine if a technology-based collaborative care model engages youth with early psychosis, and whether this will be associated with changes in smoking, physical health and nutrition.
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Affiliation(s)
- Peter Selby
- Addictions Research Program, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, Toronto, Canada.,Department of Family and Community Medicine, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Lenka Vojtila
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Canada
| | - Iqra Ashfaq
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Canada
| | - Rosa Dragonetti
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Canada
| | - Osnat C Melamed
- Department of Family and Community Medicine, Toronto, Canada.,Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Canada
| | - Rebecca Carriere
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Trillium Health Partners, Mississauga, Canada
| | - Laura LaChance
- St. Mary's Hospital Centre, McGill University, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - Sara Ahola Kohut
- Department of Psychiatry, University of Toronto, Toronto, Canada.,IBD Centre, Toronto, Canada.,SickKids Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Margaret Hahn
- Department of Psychiatry, Institute of Medical Science, Toronto, Canada.,Banting and Best Diabetes Centre, University of Toronto, Toronto, Canada.,Mental Health and Metabolism Clinic, Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Benoit H Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, Geriatric Psychiatry, University of Toronto, Toronto, Canada
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11
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Addington D, Cheng CC, French P, Killackey E, Melau M, Meneghelli A, Nordentoft M, Nossel I, Preti A, Smith J. International application of standards for health care quality, access and evaluation of services for early intervention in psychotic disorders. Early Interv Psychiatry 2021; 15:723-730. [PMID: 32449289 DOI: 10.1111/eip.12990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 04/09/2020] [Accepted: 04/28/2020] [Indexed: 11/27/2022]
Abstract
AIM Standards for health care quality, access and evaluation of early intervention in psychosis services are required to assess implementation, provide accountability to service users and funders and support quality assurance. The aim of this article is to review the application of standards in Europe and North America. METHODS Descriptive methods will be used to illustrate the organizational context in which standards are being applied and used, specific measures being applied and results so far. RESULTS Both fidelity scales and quality indicators of health care are being used. Fidelity scales are being applied in Australia, Canada, Denmark, Italy and United States. In England, quality indicators derived from the National Institute for Health and Care Excellence guidance are being used. CONCLUSION In the last 4 years, significant progress has been made in the development and application of measures that assess quality and access to evidence-based practices for early intervention in psychosis services. This represents an important step towards providing accountability, improving outcomes and service user experience. The methods used allow for comparison between the services that are assessed with the same methods, but there is a need to compare the different methods. Further research is also required to explore links between quality of care and outcomes for community mental health services that deliver early intervention in psychotic disorders.
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Affiliation(s)
- Donald Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | | | - Paul French
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Eoin Killackey
- Division Medicine, Dentistry And Health Sciences, Orygen, National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Marianne Melau
- Psychiatric Centre Copenhagen, University of Copenhagen, Denmark
| | - Anna Meneghelli
- Azienda Ospedaliera, Ospedale Niguarda Ca' Granda, Programma 2000, Milan, Italy
| | - Merete Nordentoft
- University of Copenhagen · Psychiatric Center Copenhagen, Psychiatric Center Copenhagen, Denmark
| | - Ilana Nossel
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute, New York, USA
| | - Antonio Preti
- Genneruxi Medical Center, Programma 2000, Milan, Italy
| | - Jo Smith
- School of Allied Health and Community, University of Worcester, Worcester, UK
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12
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Bertulies-Esposito B, Sicotte R, Iyer SN, Delfosse C, Girard N, Nolin M, Villeneuve M, Conus P, Abdel-Baki A. Détection et intervention précoce pour la psychose : pourquoi et comment ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088178ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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13
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Bertulies-Esposito B, Nolin M, Iyer SN, Malla A, Tibbo P, Otter N, Ferrari M, Abdel-Baki A. Où en sommes-nous? An Overview of Successes and Challenges after 30 Years of Early Intervention Services for Psychosis in Quebec: Où en sommes-nous? Un aperçu des réussites et des problèmes après 30 ans de services d'intervention précoce pour la psychose au Québec. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:536-547. [PMID: 31910659 PMCID: PMC7492883 DOI: 10.1177/0706743719895193] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Over the last 30 years, early intervention services (EIS) for first-episode psychosis (FEP) were gradually implemented in the province of Quebec. Such implementation occurred without provincial standards/guidelines and policy commitment to EIS until 2017. Although the literature highlights essential elements for EIS, studies conducted elsewhere reveal that important EIS components are often missing. No thorough review of Quebec EIS practices has ever been conducted, a gap we sought to address. METHODS Adopting a cross-sectional descriptive study design, an online survey was distributed to 18 EIS that existed in Quebec in 2016 to collect data on clinical, administrative, training, and research variables. Survey responses were compared with existing EIS service delivery recommendations. RESULTS Half of Quebec's population had access to EIS, with some regions having no programs. Most programs adhered to essential components of EIS. However, divergence from expert recommendations occurred with respect to variables such as open referral processes and patient-clinician ratio. Nonurban EIS encountered additional challenges related to their geography and lower population densities, which impacted their team size/composition and intensity of follow-up. CONCLUSIONS Most Quebec EIS offer adequate services but lack resources and organizational support to adhere to some core components. Recently, the provincial government has created EIS guidelines, invested in the development of new programs and offered implementation support from the National Centre of Excellence in Mental Health. These changes, along with continued mentoring and networking of clinicians and researchers, can help all Quebec EIS to attain and maintain recommended quality standards.
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Affiliation(s)
- Bastian Bertulies-Esposito
- Department of Psychiatry, Université de Montréal, Montreal, Quebec,
Canada
- Centre de recherche du Centre hospitalier de l’Université de
Montréal, Montreal, Quebec, Canada
| | - Marie Nolin
- Hôpital Pierre-Le Gardeur, Terrbonne, Quebec, Canada
| | - Srividya N. Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP),
Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec,
Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP),
Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec,
Canada
| | - Phil Tibbo
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nicola Otter
- Canadian Consortium for Early Intervention in Psychosis, Hamilton,
Ontario, Canada
| | - Manuela Ferrari
- Department of Psychiatry, McGill University, Montreal, Quebec,
Canada
- Douglas Mental Health University Institute, Montreal, Quebec,
Canada
| | - Amal Abdel-Baki
- Department of Psychiatry, Université de Montréal, Montreal, Quebec,
Canada
- Centre de recherche du Centre hospitalier de l’Université de
Montréal, Montreal, Quebec, Canada
- Clinique Jeunes adultes psychotiques, Centre hospitalier de
l’Université de Montréal, Montreal, Quebec, Canada
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14
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Peck CE, Lim MH, Purkiss M, Foley F, Hopkins L, Thomas N. Development of a Lived Experience-Based Digital Resource for a Digitally-Assisted Peer Support Program for Young People Experiencing Psychosis. Front Psychiatry 2020; 11:635. [PMID: 32714223 PMCID: PMC7343891 DOI: 10.3389/fpsyt.2020.00635] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/18/2020] [Indexed: 12/11/2022] Open
Abstract
This paper describes the creation of a web-based digital resource designed for tablet computer use during peer work sessions to structure discussion about recovery in early psychosis. The resource consisted of a series of videos featuring young people who have used early psychosis services discussing how they navigated issues in their own recovery. A participatory process was used to create the resource. Researchers held a series of collaborative development workshops with early psychosis service users, peer workers, other mental health practitioners, and academics. These were used to derive a framework of recovery processes relevant to young people experiencing psychosis, which was considered as useful areas of discussion within a peer work relationship. A semi-structured interview guide based on this framework was then used in video-recorded interviews with young people in recovery from psychosis. Footage was edited into 14 videos and organized into six final themes: My Journey, Self-Care, Connections, My Identity, Life, and Mental Health. The combined expertise of young mental health service users, peer support workers, mental health practitioners, and digital mental health researchers throughout the development process enabled the creation of tailored digital resource for peer work in an early psychosis service.
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Affiliation(s)
- Claire E Peck
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia.,Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Melanie Purkiss
- Headspace Youth Early Psychosis Program, Alfred Health, Melbourne, VIC, Australia
| | - Fiona Foley
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Liza Hopkins
- Headspace Youth Early Psychosis Program, Alfred Health, Melbourne, VIC, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia.,Alfred Mental and Addiction Health, Alfred Hospital, Melbourne, VIC, Australia
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15
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Tindall R, Simmons M, Allott K, Hamilton B. Disengagement Processes Within an Early Intervention Service for First-Episode Psychosis: A Longitudinal, Qualitative, Multi-Perspective Study. Front Psychiatry 2020; 11:565. [PMID: 32595545 PMCID: PMC7304238 DOI: 10.3389/fpsyt.2020.00565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/02/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Specialized early intervention services for first-episode psychosis have been well established in many countries to meet the unique needs of this group. However, with high drop-out rates, these services would benefit from understanding the factors that influence a person's decision to engage with, or disengage from, them. No research has explored the experiences of engagement and disengagement over time, from the perspectives of the person who experienced a first-episode psychosis, their caregiver, and their clinician. This information is crucial to help services better respond to the needs of the people using them. The aim of this study was to understand what causes and maintains periods of disengagement from early intervention services for first-episode psychosis over time. METHODS Using a longitudinal, qualitative approach, young people, their caregivers, and their clinicians were followed through their first year with an early intervention service for first-episode psychosis in Melbourne, Australia. Qualitative interviews were completed between 3-9 weeks, 4-7 months, and 11-15 months after entry to the service (or at discharge if earlier). Trajectory analysis was used to understand the data. RESULTS Qualitative interviews were conducted with 24 participants (55 interviews). Young people were aged 15-24 years, came from a variety of cultural backgrounds and had various psychotic diagnoses. Three major processes were identified that, over time, led to periods of service disengagement: a mismatch between service model and individual presentation (service mismatch), a lack of shared purpose (aimless engagement), and responses to individual circumstances (reactive disengagement). CONCLUSION Triangulating experiences of engagement across young people, caregivers, and clinicians allows for a comprehensive understanding of what precipitates service disengagement. This study demonstrates how early intervention services for first-episode psychosis are meeting the needs of young people and caregivers, and what areas warrant improvement. The needs of service users and patterns of disengagement vary. In turn, services must be flexible and responsive to individual circumstances. The results of this study recommend that local and international policies move away from diagnostically driven models of care, to better provide an inclusive treatment service for people with transdiagnostic mental health presentations.
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Affiliation(s)
- Rachel Tindall
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Department of Nursing, The University of Melbourne, Carlton, VIC, Australia
| | - Magenta Simmons
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Kelly Allott
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Bridget Hamilton
- Department of Nursing, The University of Melbourne, Carlton, VIC, Australia
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16
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Tindall RM, Allott K, Simmons M, Roberts W, Hamilton BE. The missing voice of engagement: an exploratory study from the perspectives of case-managers at an early intervention service for first-episode psychosis. BMC Psychiatry 2019; 19:312. [PMID: 31651268 PMCID: PMC6814013 DOI: 10.1186/s12888-019-2315-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A key component of case-management in early intervention services for first-episode psychosis is engaging a person with the service and building a relationship from which therapy and treatment can be facilitated. The aim of this study was to understand how case-managers at an early intervention service experience the process of engagement and working with varying levels of attendance and participation. METHODS Qualitative interviews were conducted with the case-managers of nine young people treated at an early intervention service for first-episode psychosis within 6 months of treatment entry. Interviews discussed the process of working with the young person and factors that influenced service engagement. Interviews were analyzed using thematic analysis. RESULTS Case-managers described a range of influences on engagement which were grouped under the themes: young person and caregiver influences on engagement, case-manager influences on engagement, and influences of the early intervention service system on engagement. The experience of engagement was described as relational, however it occurred in the context of broader influences, some of which were unable to be changed or challenged by the case-manager (e.g., resource allocation, models of treatment, young person demographics). CONCLUSION This study illustrates the challenges that case-managers face when working with young people with first-episode psychosis, and the direct influence this has on engagement with treatment. Understanding these challenges and addressing them in policy and service design may lead to improvements in young peoples' recovery from first-episode psychosis and increase case-manager job satisfaction.
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Affiliation(s)
- Rachel M. Tindall
- grid.488501.0Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, Melbourne, VIC 3052 Australia ,0000 0001 2179 088Xgrid.1008.9Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia ,0000 0001 2179 088Xgrid.1008.9Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - Kelly Allott
- grid.488501.0Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, Melbourne, VIC 3052 Australia ,0000 0001 2179 088Xgrid.1008.9Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Magenta Simmons
- grid.488501.0Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, Melbourne, VIC 3052 Australia ,0000 0001 2179 088Xgrid.1008.9Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Winsome Roberts
- 0000 0001 2179 088Xgrid.1008.9Department of Social Work, The University of Melbourne, Melbourne, Australia
| | - Bridget E. Hamilton
- 0000 0001 2179 088Xgrid.1008.9Department of Nursing, The University of Melbourne, Melbourne, Australia
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17
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Macneil C, Foster F, Nicoll A, Monfries R, Coulson L, Osman H, Grainger M, Cotton S. Effectiveness of a professional development training program in increasing knowledge of mental health clinicians specializing in early psychosis. Early Interv Psychiatry 2019; 13:1003-1010. [PMID: 30666776 DOI: 10.1111/eip.12785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/08/2018] [Accepted: 12/26/2018] [Indexed: 11/27/2022]
Abstract
AIM For early psychosis services to be effective, it is essential to have staff that are trained in evidence-based interventions in this area. In this paper, we report on research undertaken by The Early Psychosis Prevention and Intervention Centre's Statewide Services (ESW) team. The focus was on assessing knowledge acquisition in early psychosis clinicians that had attended ESW's specialist training. METHODS Between October 2012 and October 2017, data were collected from a large cohort of clinicians that had attended 46 ESW workshops covering topics identified in international guidelines as key components of early psychosis service provision. Participants were asked to complete between 3 and 11 pre- and post-workshop short answer and/or multiple choice questions that related to learning outcomes for the workshop. The percentage of correct responses before and after the workshop was compared for each participant, with a cumulative measure taken to provide information regarding knowledge acquisition across each workshop. RESULTS Participant compliance was high (89.7%) with 962 completed questionnaires being collected from 1073 attendees across the workshops. Results showed that the ESW training led to a statistically significant increase in clinician knowledge from pre-training scores of 47.2% correct, to 83.5% correct answers at the conclusion of training (pre M = 47.2%, SD = 28.8; post M = 83.5%, SD = 23.7; t[890] = -35.66, P < 0.001). CONCLUSIONS Training that utilized adult learning principles had a strong focus on evidence-based interventions, and used clinical examples to embed core principles, led to a statistically significant increase in early intervention clinician knowledge.
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Affiliation(s)
- Craig Macneil
- EPPIC Statewide Services, Orygen Youth Health, Parkville, Victoria, Australia.,Early Psychosis Prevention and Intervention Centre, Orygen Youth Health, Parkville, Victoria, Australia
| | - Frances Foster
- EPPIC Statewide Services, Orygen Youth Health, Parkville, Victoria, Australia
| | - Amanda Nicoll
- EPPIC Statewide Services, Orygen Youth Health, Parkville, Victoria, Australia
| | - Richard Monfries
- EPPIC Statewide Services, Orygen Youth Health, Parkville, Victoria, Australia
| | - Lucas Coulson
- EPPIC Statewide Services, Orygen Youth Health, Parkville, Victoria, Australia.,Early Psychosis Prevention and Intervention Centre, Orygen Youth Health, Parkville, Victoria, Australia
| | - Helen Osman
- EPPIC Statewide Services, Orygen Youth Health, Parkville, Victoria, Australia
| | - Michelle Grainger
- EPPIC Statewide Services, Orygen Youth Health, Parkville, Victoria, Australia.,Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sue Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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18
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Brooke LE, Lin A, Ntoumanis N, Gucciardi DF. Is sport an untapped resource for recovery from first episode psychosis? A narrative review and call to action. Early Interv Psychiatry 2019; 13:358-368. [PMID: 30039635 DOI: 10.1111/eip.12720] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/17/2018] [Accepted: 06/19/2018] [Indexed: 01/19/2023]
Abstract
AIM The objective of this narrative review is to address the question: Should sport-based life skills interventions be developed for young people recovering from first episode psychosis? METHODS A prose was developed through a broad, critical narrative review of literatures on (1) first episode psychosis recovery (FEP); and (2) life skills and sport, highlighting the conceptual (and limited empirical) links between the two. This style of review allowed for a critical examination of evidence from seemingly distinct literatures to address a question yet to be explored empirically. RESULTS The review process highlighted important overlaps between psychosis recovery and sport. A review of the FEP recovery literature reveals that important components of an individual's recovery following a psychotic episode are: (1) physical activity, (2) opportunities to build life skills, and (3) social connectivity. A review of the sport and life skills literature suggests that sport can be a powerful platform from which to: (1) promote physical activity, (2) teach life skills, and (3) foster social connectivity within vulnerable populations. Despite the clear links between the two fields, mental health interventions that combine both life skills training components and physical activity in a context that promotes social connectivity are scarce to none. CONCLUSIONS We suggest that sport-based interventions could be an opportunity to provide life skills training, social connectivity and physical activity opportunities in one intervention to individuals recovering from their first psychotic episode. We call for their development, and provide empirically-based recommendations for intervention design.
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Affiliation(s)
- Lauren E Brooke
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Nikos Ntoumanis
- School of Psychology, Curtin University, Perth, WA, Australia
| | - Daniel F Gucciardi
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
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19
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Addington D, Birchwood M, Jones P, Killackey E, McDaid D, Melau M, Mizuno M, Mueser K, Nordentoft M. Fidelity scales and performance measures to support implementation and quality assurance for first episode psychosis services. Early Interv Psychiatry 2018; 12:1235-1242. [PMID: 29882236 DOI: 10.1111/eip.12684] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/05/2018] [Accepted: 05/16/2018] [Indexed: 11/30/2022]
Abstract
AIM The purpose of this paper is to review fidelity and outcome measures which can be used to support broad implementation of first episode psychosis services and ensure quality of existing services. First episode psychosis services use a combination of evidence-based practices to improve the outcome of a first episode of psychosis and the early stages of schizophrenia. Now that there is an established international evidence base to show that they are effective, efforts are being made to make such services widely available as a routine part of health care. METHODS We provide an overview of the literature from the perspective of an expert task force that was commissioned to report to the board of the International Early Psychosis Association IEPA. First, we examined the evidence-based components that underpin first episode psychosis services and identified common elements. Next, we reviewed the availability of fidelity measures and outcome indicators, finally we reviewed how broadly these services are delivered internationally, and the barriers to ensuring broad access to quality services. RESULTS There is a growing consensus about the elements required to deliver effective services. Fidelity scales and performance measures are available to assess quality, access, and outcome. First episode psychosis services are variably offered in high-income countries and rarely with attention to access and quality of services. Several strategies to promote implementation are identified. CONCLUSIONS Fidelity scales and outcome measure are valuable resources to support widespread implementation and quality assurance for first episode psychosis services.
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Affiliation(s)
- Donald Addington
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | | | - Peter Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Eoin Killackey
- Center for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David McDaid
- Personal Social Services Research Unit London School of Economics and Political Science, London, UK
| | - Marianne Melau
- The Capital Region of Denmark, Copenhagen University Hospital, Copenhagen, Denmark
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University, Tokyo, Japan
| | - Kim Mueser
- Centre for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts
| | - Merete Nordentoft
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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20
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Hetrick SE, O'Connor DA, Stavely H, Hughes F, Pennell K, Killackey E, McGorry PD. Development of an implementation guide to facilitate the roll-out of early intervention services for psychosis. Early Interv Psychiatry 2018; 12:1100-1111. [PMID: 28177191 DOI: 10.1111/eip.12420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/06/2016] [Accepted: 11/11/2016] [Indexed: 11/29/2022]
Abstract
AIM Our aim was to develop an implementation guide that was informed by an analysis of context-specific barriers and enablers, behaviour change theory, as well as evidence about the effects of implementation interventions, for the establishment and scaling up of an early intervention model for psychosis (called Early Psychosis Prevention and Intervention Centre (EPPIC)). METHODS We used a systematic approach involving four steps. First, the target behaviours of the EPPIC model for implementation were specified. Second, a consultation was undertaken to explore the barriers and enablers to undertaking these priority minimum standard clinical behaviours. Third, an implementation strategy that included a range of behaviour change techniques tailored to address the identified barriers was developed. Finally, a tool to assess whether those implementing the EPPIC model maintained fidelity to the implementation strategy was designed. RESULTS We identified a range of barriers that could act to dilute the core components of the EPPIC model and compromise its implementation. An implementation strategy using theory and evidence-based strategies for behaviour change was designed to address these barriers. CONCLUSIONS The process we used in the development of the implementation strategy provided a unique opportunity to consider the essential areas to cover, how to make information easily understandable and accessible while noting the complexity of issues involved in not only implementation, but also the scaling up of the EPPIC model for services.
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Affiliation(s)
- Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre of Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Denise A O'Connor
- Implementation Consultant, School of Public Health and Preventive Medicine at Monash University, Melbourne, Australia
| | - Heather Stavely
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Frank Hughes
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Kerryn Pennell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre of Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre of Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre of Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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21
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Tindall RM, Simmons MB, Allott K, Hamilton BE. Essential ingredients of engagement when working alongside people after their first episode of psychosis: A qualitative meta-synthesis. Early Interv Psychiatry 2018; 12:784-795. [PMID: 29624917 DOI: 10.1111/eip.12566] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 12/08/2017] [Accepted: 02/04/2018] [Indexed: 11/26/2022]
Abstract
AIM Early intervention services (EISs) for first-episode psychosis (FEP) have been established internationally, however, service disengagement is a recurrent concern resulting in unplanned treatment cessation. The implications of this are far-reaching due to the financial and personal costs associated with untreated symptoms. The aim of this meta-synthesis was to collect, interpret and synthesize qualitative research about how engagement is experienced within EISs for FEP. METHODS A systematic search was conducted in PsycINFO, Ovid MEDLINE and Ovid Emcare from date of conception to November 2016. Following initial screening, 91 abstracts and 13 full texts were reviewed for eligibility. Nine studies were then critically appraised using the CASP tool for qualitative studies, data were systematically extracted and results were synthesized using constant comparison and reciprocal translational analysis. RESULTS Nine qualitative studies explored engagement with EISs, from the perspectives of service users and their caregivers. No studies were found from the perspectives of clinicians or services. All 9 studies employed an inductive methodology, within an interpretivist epistemology. Five main themes were identified: experiences of finding help; factors promoting engagement; the therapeutic relationship; the role of caregivers in supporting engagement; and factors impacting ongoing engagement. CONCLUSIONS There is a critical need to stimulate discussion around this multifaceted phenomenon, including a continued focus on the roles of key stakeholders and clinical models that may further facilitate collaboration in treatment plans and recovery.
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Affiliation(s)
- Rachel M Tindall
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Magenta B Simmons
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bridget E Hamilton
- Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
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22
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Csillag C, Nordentoft M, Mizuno M, McDaid D, Arango C, Smith J, Lora A, Verma S, Di Fiandra T, Jones PB. Early intervention in psychosis: From clinical intervention to health system implementation. Early Interv Psychiatry 2018; 12:757-764. [PMID: 29143456 DOI: 10.1111/eip.12514] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 09/06/2017] [Accepted: 09/13/2017] [Indexed: 12/20/2022]
Abstract
AIM Early intervention in psychosis (EIP) is a well-established approach with the intention of early detection and treatment of psychotic disorders. Its clinical and economic benefits are well documented. This paper presents basic aspects of EIP services, discusses challenges to their implementation and presents ideas and strategies to overcome some of these obstacles. METHODS This paper is a narrative review about the evidence supporting EIP, with examples of successful implementation of EIP and of cases where major obstacles still need to be overcome. RESULTS Experience from successfully implemented EIP services into the mental healthcare system have generated evidence, concepts and specific strategies that might serve as guidance or inspiration in other countries or systems where EIP is less well developed or not developed at all. Previous experience has made clear that evidence of clinical benefits alone is not enough to promote implementation, as economic arguments and political and social pressure have shown to be important elements in efforts to achieve implementation. CONCLUSIONS Users' narratives, close collaboration with community organizations and support from policy-makers and known people within the community championing early intervention (EI) services are just a few of the approaches that should be considered in campaigns for implementation of EI services. Fast progress in implementation is possible.
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Affiliation(s)
- Claudio Csillag
- Mental Health Centre North Zealand, University of Copenhagen, Hilleroed, Denmark
| | | | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - David McDaid
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Celso Arango
- Hospital General Universitario Gregorio Marañón, Universidad Complutense, School of Medicine, CIBERSAM, IiSGM, Madrid, Spain
| | - Jo Smith
- Institute of Health and Society, University of Worcester, Worcester, UK
| | | | - Swapna Verma
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore, Singapore
| | | | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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23
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Tindall RM, Allott K, Simmons M, Roberts W, Hamilton BE. Engagement at entry to an early intervention service for first episode psychosis: an exploratory study of young people and caregivers. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2018. [DOI: 10.1080/17522439.2018.1502341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Rachel M Tindall
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
- Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Magenta Simmons
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Winsome Roberts
- Department of Social Work, The University of Melbourne, Melbourne, Australia
| | - Bridget E Hamilton
- Department of Nursing, The University of Melbourne, Melbourne, Australia
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24
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Hughes F, Hebel L, Badcock P, Parker AG. Ten guiding principles for youth mental health services. Early Interv Psychiatry 2018; 12:513-519. [PMID: 28402028 DOI: 10.1111/eip.12429] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/13/2016] [Accepted: 12/24/2016] [Indexed: 11/30/2022]
Abstract
AIMS Guiding principles are arguably central to the development of any health service. The aim of this article is to report on the outcomes of a youth mental health (YMH) community of practice (CoP), which identified a range of guiding principles that provide a clear point of comparison for the only other set of principles for YMH service delivery proposed to date. METHODS A YMH CoP was established in 2010 as part of the Victorian State Government approach to improving YMH care. An initial literature search was undertaken to locate articles on YMH service delivery. A number of common themes were identified, which the YMH community of practice (YMHCoP) members then elaborated upon by drawing from their collective experience of the YMH sector. The resultant themes were then refined through subsequent group discussions to derive a definitive set of guiding principles. These principles were then augmented by a second literature search conducted in July 2015. RESULTS Fifteen key themes were derived from the initial literature search and YMH CoP discussions. These were refined by the YMH CoP to produce 10 guiding principles for YMH service development. These are discussed through reference to the relevant literature, using the only other article on principles of YMH service delivery as a notable point of comparison. CONCLUSION The 10 principles identified may be useful for quality improvement and are likely to have international relevance. We suggest the timely pursuit of an international consensus on guiding principles for service delivery under the auspices of a peak body for YMH.
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Affiliation(s)
- Frank Hughes
- Centre for Youth Mental Health, Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Lisa Hebel
- North-Western Mental Health, Melbourne Health, Melbourne, Victoria, Australia
| | - Paul Badcock
- Centre for Youth Mental Health, Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alexandra G Parker
- Centre for Youth Mental Health, Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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25
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Hanlon MC, Campbell LE, Single N, Coleman C, Morgan VA, Cotton SM, Stain HJ, Castle DJ. Men and women with psychosis and the impact of illness-duration on sex-differences: The second Australian national survey of psychosis. Psychiatry Res 2017. [PMID: 28633054 DOI: 10.1016/j.psychres.2017.06.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We aimed to examine and compare sex-differences in people receiving treatment for psychotic illnesses in community settings, based on long or short duration of illness; expecting association between longer illness-duration and worse outcomes in women and men. Clinical, demographic and service-use data from the Survey of High Impact Psychosis were analysed by sex and duration of illness (≤5 years; ≥6 years), using independent t-tests, chi-square tests, one-way ANOVA, and Cramer's V. Of the 1825 participants, 47% had schizophrenia, 17.5% bipolar and 16.1% schizo-affective disorders. More women than men had undertaken post-school education, maintained relationships, and been living in their own homes. Women with a shorter-illness-duration showed social functioning equivalent to non-ill women in the general population. Men tended to have an early illness onset, show premorbid dysfunction, be single, show severe disability, and to use illicit substances. Men with a longer-illness-duration were very socially disadvantaged and isolated, often experiencing homelessness and substance use. Men with a short-illness-duration were most likely to be in paid employment, but two-thirds earned less than $AUD500 per fortnight. Men with longer-illness-duration showed most disability, socially and globally. Interventions should be guided by diagnosis, but also by a person's sex and duration of illness.
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Affiliation(s)
- Mary-Claire Hanlon
- The University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Brain and Mental Health, The University of Newcastle, Callaghan, NSW, Australia; Calvary Mater Newcastle, Waratah, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Linda E Campbell
- The University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Priority Research Centre GrowUpWell and the School of Psychology, University of Newcastle, Australia
| | | | | | - Vera A Morgan
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, WA, Australia; North Metropolitan Health Service Mental Health, Perth, WA, Australia
| | - Susan M Cotton
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia
| | - Helen J Stain
- Priority Research Centre for Brain and Mental Health, The University of Newcastle, Callaghan, NSW, Australia; School of Social and Health Sciences, Leeds Trinity University, Horsforth, Leeds, UK
| | - David J Castle
- St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
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26
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Breitborde NJK, Moe AM, Ered A, Ellman LM, Bell EK. Optimizing psychosocial interventions in first-episode psychosis: current perspectives and future directions. Psychol Res Behav Manag 2017; 10:119-128. [PMID: 28490910 PMCID: PMC5414722 DOI: 10.2147/prbm.s111593] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Psychotic-spectrum disorders such as schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features are devastating illnesses accompanied by high levels of morbidity and mortality. Growing evidence suggests that outcomes for individuals with psychotic-spectrum disorders can be meaningfully improved by increasing the quality of mental health care provided to these individuals and reducing the delay between the first onset of psychotic symptoms and the receipt of adequate psychiatric care. More specifically, multicomponent treatment packages that 1) simultaneously target multiple symptomatic and functional needs and 2) are provided as soon as possible following the initial onset of psychotic symptoms appear to have disproportionately positive effects on the course of psychotic-spectrum disorders. Yet, despite the benefit of multicomponent care for first-episode psychosis, clinical and functional outcomes among individuals with first-episode psychosis participating in such services are still suboptimal. Thus, the goal of this review is to highlight putative strategies to improve care for individuals with first-episode psychosis with specific attention to optimizing psychosocial interventions. To address this goal, we highlight four burgeoning areas of research with regard to optimization of psychosocial interventions for first-episode psychosis: 1) reducing the delay in receipt of evidence-based psychosocial treatments; 2) synergistic pairing of psychosocial interventions; 3) personalized delivery of psychosocial interventions; and 4) technological enhancement of psychosocial interventions. Future research on these topics has the potential to optimize the treatment response to evidence-based psychosocial interventions and to enhance the improved (but still suboptimal) treatment outcomes commonly experienced by individuals with first-episode psychosis.
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Affiliation(s)
- Nicholas JK Breitborde
- Department of Psychiatry and Behavioral Health
- Department of Psychology, The Ohio State University, Columbus, OH
| | | | - Arielle Ered
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA
| | - Emily K Bell
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
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27
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Cuando la asistencia no sigue a la evidencia: el caso de la falta de programas de intervención temprana en psicosis en España. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2017; 10:78-86. [DOI: 10.1016/j.rpsm.2017.01.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 11/11/2016] [Accepted: 01/03/2017] [Indexed: 12/14/2022]
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28
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Abstract
Available data have demonstrated the clinical benefits and cost-effectiveness of multi-component treatment packages for individuals early in the course of psychotic-spectrum disorders. In response, an unprecedented effort aims to disseminate such multi-component treatment programs—referred to as Coordinated Specialty Care (CSC)—throughout the United States. We review the evidence in support of CSC care for first-episode psychosis and highlight specific policy reforms that may facilitate the successful dissemination and eventual improvement of CSC programs for first-episode psychosis. Among proposed reforms are novel financing strategies for CSC services and incentivizing of continued collaboration between academic and community agencies to facilitate sustained dissemination and refinement of CSC.
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29
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Csillag C, Nordentoft M, Mizuno M, Jones PB, Killackey E, Taylor M, Chen E, Kane J, McDaid D. Early intervention services in psychosis: from evidence to wide implementation. Early Interv Psychiatry 2016; 10:540-546. [PMID: 26362703 DOI: 10.1111/eip.12279] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/17/2015] [Indexed: 11/27/2022]
Abstract
AIM Early intervention (EI) in psychosis is a comprehensive and evidence-based approach aimed at detection and treatment of psychotic symptoms in their early stages. This paper presents core features and noteworthy aspects of the evidence basis and limitations of EI, the importance of programme fidelity, challenges for its widespread dissemination and economic perspectives related to it. METHODS This paper is a narrative review about the evidence supporting EI and the challenges to its widespread dissemination. RESULTS In spite of evidence of a wide range of benefits, widespread dissemination has been slow, and even currently implemented programmes might be threatened. This reflects in part the shortcomings of mental health care in general, such as low priority for funding, stigma and structural problems. Successful examples of advocacy, mobilization and destigmatization campaigns have overcome these difficulties. CONCLUSIONS Funding for mental health in general and for EI services appears low relative to need. One key argument for better funding for EI can be found in its favourable cost-effectiveness, but not all stakeholders beyond mental health administrators are aware of this. Positive impacts of EI programmes on excess unemployment and tax forgone suggest that social affairs and labour ministries - and not only health ministries - could be more involved in governance of mental health issues; ministries of justice and education are other sector stakeholders than can benefit. Wider dissemination of EI services will probably benefit from better integration of potential funders, promotion of joint targets and shared financial or budgetary incentives.
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Affiliation(s)
- Claudio Csillag
- Mental Health Centre North Zealand, University of Copenhagen, Copenhagen, Denmark.
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Masafumi Mizuno
- Department of Neuropsychiatry, Toho University School of Medicine, Tokyo, Japan
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Eóin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Taylor
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Eric Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | - John Kane
- Department of Psychiatry, Hofstra North Shore-Long Island Jewish School of Medicine, Hempstead, New York, USA
| | - David McDaid
- Health and Social Care, London School of Economics and Political Science, London, UK
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30
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Malla A, Iyer S, McGorry P, Cannon M, Coughlan H, Singh S, Jones P, Joober R. From early intervention in psychosis to youth mental health reform: a review of the evolution and transformation of mental health services for young people. Soc Psychiatry Psychiatr Epidemiol 2016; 51:319-26. [PMID: 26687237 DOI: 10.1007/s00127-015-1165-4] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/29/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The objective of this review is to report on recent developments in youth mental health incorporating all levels of severity of mental disorders encouraged by progress in the field of early intervention in psychotic disorders, research in deficiencies in the current system and social advocacy. METHODS The authors have briefly reviewed the relevant current state of knowledge, challenges and the service and research response across four countries (Australia, Ireland, the UK and Canada) currently active in the youth mental health field. RESULTS Here we present information on response to principal challenges associated with improving youth mental services in each country. Australia has developed a model comprised of a distinct front-line youth mental health service (Headspace) to be implemented across the country and initially stimulated by success in early intervention in psychosis; in Ireland, Headstrong has been driven primarily through advocacy and philanthropy resulting in front-line services (Jigsaw) which are being implemented across different jurisdictions; in the UK, a limited regional response has addressed mostly problems with transition from child-adolescent to adult mental health services; and in Canada, a national multi-site research initiative involving transformation of youth mental health services has been launched with public and philanthropic funding, with the expectation that results of this study will inform implementation of a transformed model of service across the country including indigenous peoples. CONCLUSIONS There is evidence that several countries are now engaged in transformation of youth mental health services and in evaluation of these initiatives.
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Affiliation(s)
- Ashok Malla
- Department of Psychiatry, McGill University, Montreal, QC, Canada. .,ACCESS Open Minds Canada, Douglas Mental Health University Institute, Montreal, Canada. .,Douglas Hospital Research Centre, ACCESS Open Minds Pavilion, 6625 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada.
| | - Srividya Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,ACCESS Open Minds Canada, Douglas Mental Health University Institute, Montreal, Canada
| | | | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Swaran Singh
- Division of Mental Health, Warwick University, Coventry, England, UK
| | - Peter Jones
- Department of Psychiatry, Cambridge University, Cambridge, England, UK
| | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,ACCESS Open Minds Canada, Douglas Mental Health University Institute, Montreal, Canada
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31
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Schulz SC, Murray A, Silberschmidt A, Bond DJ. A Multidisciplinary First-Episode Psychosis Program. Psychiatr Ann 2015. [DOI: 10.3928/00485713-20151103-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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32
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Breitborde NJK, Bell EK, Dawley D, Woolverton C, Ceaser A, Waters AC, Dawson SC, Bismark AW, Polsinelli AJ, Bartolomeo L, Simmons J, Bernstein B, Harrison-Monroe P. The Early Psychosis Intervention Center (EPICENTER): development and six-month outcomes of an American first-episode psychosis clinical service. BMC Psychiatry 2015; 15:266. [PMID: 26511605 PMCID: PMC4625429 DOI: 10.1186/s12888-015-0650-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 10/14/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND There is growing evidence that specialized clinical services targeted toward individuals early in the course of a psychotic illness may be effective in reducing both the clinical and economic burden associated with these illnesses. Unfortunately, the United States has lagged behind other countries in the delivery of specialized, multi-component care to individuals early in the course of a psychotic illness. A key factor contributing to this lag is the limited available data demonstrating the clinical benefits and cost-effectiveness of early intervention for psychosis among individuals served by the American mental health system. Thus, the goal of this study is to present clinical and cost outcome data with regard to a first-episode psychosis treatment center within the American mental health system: the Early Psychosis Intervention Center (EPICENTER). METHODS Sixty-eight consecutively enrolled individuals with first-episode psychosis completed assessments of symptomatology, social functioning, educational/vocational functioning, cognitive functioning, substance use, and service utilization upon enrollment in EPICENTER and after 6 months of EPICENTER care. All participants were provided with access to a multi-component treatment package comprised of cognitive behavioral therapy, family psychoeducation, and metacognitive remediation. RESULTS Over the first 6 months of EPICENTER care, participants experienced improvements in symptomatology, social functioning, educational/vocational functioning, cognitive functioning, and substance abuse. The average cost of care during the first 6 months of EPICENTER participation was lower than the average cost during the 6-months prior to joining EPICENTER. These savings occurred despite the additional costs associated with the receipt of EPICENTER care and were driven primarily by reductions in the utilization of inpatient psychiatric services and contacts with the legal system. CONCLUSIONS The results of our study suggest that multi-component interventions for first-episode psychosis provided in the US mental health system may be both clinically-beneficial and cost-effective. Although additional research is needed, these findings provide preliminary support for the growing delivery of specialized multi-component interventions for first-episode psychosis within the United States. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01570972; Date of Trial Registration: November 7, 2011.
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Affiliation(s)
- Nicholas J. K. Breitborde
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio USA ,Department of Psychiatry, The University of Arizona, Tucson, Arizona USA
| | - Emily K. Bell
- Department of Psychiatry, The University of Arizona, Tucson, Arizona USA
| | - David Dawley
- Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA.
| | - Cindy Woolverton
- Department of Psychology, The University of Arizona, Tucson, Arizona, USA.
| | - Alan Ceaser
- Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA. .,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA.
| | - Allison C. Waters
- Department of Psychiatry, The University of Arizona, Tucson, Arizona USA ,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia USA
| | - Spencer C. Dawson
- Department of Psychology, The University of Arizona, Tucson, Arizona USA
| | - Andrew W. Bismark
- VISN-22 Mental Illness, Research, Education and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, California USA
| | | | - Lisa Bartolomeo
- Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA.
| | - Jessica Simmons
- Department of Education, The University of Arizona, Tucson, Arizona, USA.
| | - Beth Bernstein
- Department of Psychiatry, The University of Arizona, Tucson, Arizona, USA.
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33
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Employment and educational outcomes in early intervention programmes for early psychosis: a systematic review. Epidemiol Psychiatr Sci 2015; 24:446-57. [PMID: 25016950 PMCID: PMC8367356 DOI: 10.1017/s2045796014000419] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS Young adults with early psychosis want to pursue normal roles - education and employment. This paper summarises the empirical literature on the effectiveness of early intervention programmes for employment and education outcomes. METHODS We conducted a systematic review of employment/education outcomes for early intervention programmes, distinguishing three programme types: (1) those providing supported employment, (2) those providing unspecified vocational services and (3) those without vocational services. We summarised findings for 28 studies. RESULTS Eleven studies evaluated early intervention programmes providing supported employment. In eight studies that reported employment outcomes separately from education outcomes, the employment rate during follow-up for supported employment patients was 49%, compared with 29% for patients receiving usual services. The two groups did not differ on enrolment in education. In four controlled studies, meta-analysis showed that the employment rate for supported employment participants was significantly higher than for control participants, odds ratio = 3.66 [1.93-6.93], p < 0.0001. Five studies (four descriptive and one quasi-experimental) of early intervention programmes evaluating unspecified vocational services were inconclusive. Twelve studies of early intervention programmes without vocational services were methodologically heterogeneous, using diverse methods for evaluating vocational/educational outcomes and precluding a satisfactory meta-analytic synthesis. Among studies with comparison groups, 7 of 11 (64%) reported significant vocational/education outcomes favouring early intervention over usual services. CONCLUSIONS In early intervention programmes, supported employment moderately increases employment rates but not rates of enrolment in education. These improvements are in addition to the modest effects early programmes alone have on vocational/educational outcomes compared with usual services.
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34
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McGorry PD. Australian Early Psychosis Research Network: national collaboration, international competitive advantage. Med J Aust 2015; 202:170-1. [PMID: 25716588 DOI: 10.5694/mja14.00914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 10/22/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Patrick D McGorry
- ORYGEN Youth Health Research Centre, University of Melbourne, Melbourne, VIC, Australia.
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35
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Abstract
Early intervention for potentially serious disorder is a fundamental feature of healthcare across the spectrum of physical illness. It has been a major factor in the reductions in morbidity and mortality that have been achieved in some of the non-communicable diseases, notably cancer and cardiovascular disease. Over the past two decades, an international collaborative effort has been mounted to build the evidence and the capacity for early intervention in the psychotic disorders, notably schizophrenia, where for so long deep pessimism had reigned. The origins and rapid development of early intervention in psychosis are described from a personal and Australian perspective. This uniquely evidence-informed, evidence-building and cost-effective reform provides a blueprint and launch pad to radically change the wider landscape of mental health care and dissolve many of the barriers that have constrained progress for so long.
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Affiliation(s)
- Patrick D McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
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36
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Schvarcz A, Bearden CE. Early Detection of Psychosis: Recent Updates from Clinical High-Risk Research. Curr Behav Neurosci Rep 2015; 2:90-101. [PMID: 26693133 DOI: 10.1007/s40473-015-0033-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The debilitating nature of schizophrenia necessitates early detection of individuals at clinical high-risk (CHR) in order to facilitate early intervention. In particular, comparisons between those who develop fully psychotic features (CHR+) and those who do not (CHR-) offer the opportunity to reveal distinct risk factors for psychosis, as well as possible intervention target points. Recent studies have investigated baseline clinical, neurocognitive, neuroanatomic, neurohormonal, and psychophysiological predictors of outcome; premorbid social dysfunction, deficits in neurocognitive performance, neuroanatomic changes, and hypothalamic-pituitary-adrenal (HPA) axis dysfunction have been implicated in psychosis emergence. However, several challenges within CHR research remain: heterogeneity in long-term diagnostic outcome, the variability of research tools and definitions utilized, and limited longitudinal follow-up. Future work in the field should focus on replication via extended longitudinal designs, aim to explore the trajectories and inter-relationships of hypothesized biomarkers, and continue to investigate interventions that seek to prevent psychosis emergence through symptom reduction.
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Affiliation(s)
- Ariel Schvarcz
- Department of Psychology, University of California, Los Angeles
| | - Carrie E Bearden
- Department of Psychology, University of California, Los Angeles ; Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles ; Brain Research Institute, University of California, Los Angeles
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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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