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Engel L, Alvarez-Jimenez M, Cagliarini D, D’Alfonso S, Faller J, Valentine L, Koval P, Bendall S, O’Sullivan S, Rice S, Miles C, Penn DL, Phillips J, Russon P, Lederman R, Killackey E, Lal S, Maree Cotton S, Gonzalez-Blanch C, Herrman H, McGorry PD, Gleeson JFM, Mihalopoulos C. The Cost-Effectiveness of a Novel Online Social Therapy to Maintain Treatment Effects From First-Episode Psychosis Services: Results From the Horyzons Randomized Controlled Trial. Schizophr Bull 2024; 50:427-436. [PMID: 37261464 PMCID: PMC10919787 DOI: 10.1093/schbul/sbad071] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Digital interventions have potential applications in promoting long-term recovery and improving outcomes in first-episode psychosis (FEP). This study aimed to evaluate the cost-effectiveness of Horyzons, a novel online social therapy to support young people aged 16-27 years following discharge from FEP services, compared with treatment as usual (TAU) from a healthcare sector and a societal perspective. STUDY DESIGN A cost-effectiveness analysis (CEA), based on the change in social functioning, and a cost-utility analysis (CUA) using quality-adjusted life years were undertaken alongside a randomized controlled trial. Intervention costs were determined from study records; resources used by patients were collected from a resource-use questionnaire and administrative data. Mean costs and outcomes were compared at 18 months and incremental cost-effectiveness ratios were calculated. Uncertainty analysis using bootstrapping and sensitivity analyses was conducted. STUDY RESULTS The sample included 170 participants: Horyzons intervention group (n = 86) and TAU (n = 84). Total costs were significantly lower in the Horyzons group compared with TAU from both the healthcare sector (-AU$4789.59; P < .001) and the societal perspective (-AU$5131.14; P < .001). In the CEA, Horyzons was dominant, meaning it was less costly and resulted in better social functioning. In the CUA, the Horyzons intervention resulted in fewer costs but also yielded fewer QALYs. However, group differences in outcomes were not statistically significant. When young people engaged more with the platform, costs were shown to decrease and outcomes improved. CONCLUSIONS The Horyzons intervention offers a cost-effective approach for improving social functioning in young people with FEP after discharge from early intervention services.
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Affiliation(s)
- Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Daniela Cagliarini
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Simon D’Alfonso
- School of Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Jan Faller
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lee Valentine
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Koval
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Sarah Bendall
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shaunagh O’Sullivan
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Simon Rice
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Chris Miles
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Jess Phillips
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Penni Russon
- School of Communication, University of Technology Sydney, Sydney, NWS, Australia
| | - Reeva Lederman
- School of Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sue Maree Cotton
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cesar Gonzalez-Blanch
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- University Hospital Marques de Valdecilla-IDIVAL, Santander, Spain
| | - Helen Herrman
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Patrick D McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - John F M Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Deakin Health Economics, Deakin University, Burwood, VIC, Australia
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2
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Tsiglopoulos J, Pearson N, Mifsud N, Castagnini E, Allott K, Thompson A, Killackey E, McGorry P, O'Donoghue B. The prevalence of vitamin D deficiency and associated factors in first-episode psychosis. Early Interv Psychiatry 2024; 18:237-242. [PMID: 37700506 DOI: 10.1111/eip.13465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 01/29/2023] [Accepted: 08/22/2023] [Indexed: 09/14/2023]
Abstract
AIM Vitamin D deficiency is prevalent in people with established psychotic disorders, but less is known about vitamin D levels in people with first-episode psychosis (FEP). This study aimed to determine the prevalence of vitamin D deficiency in people with FEP and identify the factors associated with vitamin D status. METHODS This was a prospective cohort study nested within a randomized controlled trial, which included 37 young people with an FEP with minimal antipsychotic medication exposure. RESULTS Twenty-four percent of participants were vitamin D deficient, and a further 30% were vitamin D insufficient. There was no association between vitamin D and demographic factors or clinical symptoms (positive, negative, general psychopathology and depressive symptoms) or cognition and functioning. However, vitamin D levels were associated with season of sampling. CONCLUSIONS Considering the longer-term adverse effects associated with vitamin D deficiency, it is warranted to ensure this clinical population receives supplementation if indicated.
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Affiliation(s)
- Jonathan Tsiglopoulos
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Nicholas Pearson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Nathan Mifsud
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Emily Castagnini
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Kelly Allott
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Andrew Thompson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Eoin Killackey
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Patrick McGorry
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Brian O'Donoghue
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
- Department of Psychiatry, University College Dublin, Dublin, Ireland
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3
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Brinchmann B, Wittlund S, Lorentzen T, Moe C, McDaid D, Killackey E, Rinaldi M, Mykletun A. The societal impact of individual placement and support implementation on employment outcomes for young adults receiving temporary health-related welfare benefits: a difference-in-differences study. Psychol Med 2024:1-9. [PMID: 38197145 DOI: 10.1017/s0033291723003744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Individual placement and support (IPS) is an evidence-based practice that helps individuals with mental illness gain and retain employment. IPS was implemented for young adults at a municipality level through a cross-sectoral collaboration between specialist mental healthcare, primary mental healthcare, and the government funded employment service (NAV). We investigated whether IPS implementation had a causal effect on employment outcomes for all young adults in receipt of a temporary health-related rehabilitation (work assessment allowance, WAA) welfare benefit, measured at the societal level compared to municipalities that did not implement IPS. METHOD We used a difference in differences design to estimate the effects of IPS implementation on the outcome of workdays per year using longitudinal registry data. We estimate the average effect of being exposed to IPS implementation during four-years of implementation compared to ten control municipalities without IPS for all WAA recipients. RESULTS We found a significant, positive, causal effect on societal level employment outcomes of 5.6 (p = 0.001, 95% CI 2.7-8.4) increased workdays per year per individual, equivalent to 12.7 years of increased work in the municipality where IPS was implemented compared to municipalities without IPS. Three years after initial exposure to IPS implementation individuals worked, on average, 10.5 more days per year equating to 23.8 years of increased work. CONCLUSIONS Implementing IPS as a cross sectoral collaboration at a municipality level has a significant, positive, causal, societal impact on employment outcomes for all young adults in receipt of a temporary health-related rehabilitation welfare benefit.
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Affiliation(s)
- Beate Brinchmann
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
| | - Sina Wittlund
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
- Institute of Sociology, University of Bergen, Bergen, Norway
- Department of Community Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
| | - Thomas Lorentzen
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
- Institute of Sociology, University of Bergen, Bergen, Norway
| | - Cathrine Moe
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
- Faculty of Nursing and Health sciences, Nord University, Bodø, Norway
| | - David McDaid
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Eoin Killackey
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Miles Rinaldi
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
- South West London and St George's Mental Health NHS Trust, London, UK
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Arnstein Mykletun
- Centre for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
- Department of Community Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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4
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Koops S, Allott K, de Haan L, Chen E, Hui C, Killackey E, Long M, Moncrieff J, Sommer I, Stürup AE, Wunderink L, Begemann M. Addressing the Evidence to Practice Gap: What to Expect From International Antipsychotic Dose Reduction Studies in the Tapering Anti-Psychotics and Evaluating Recovery Consortium. Schizophr Bull 2024; 50:5-8. [PMID: 37625022 PMCID: PMC10754158 DOI: 10.1093/schbul/sbad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Affiliation(s)
- Sanne Koops
- Department of Psychiatry, University Medical Center Groningen, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - Kelly Allott
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lieuwe de Haan
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
- Arkin, Institute for Mental Health, Amsterdam, The Netherlands
| | - Eric Chen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christy Hui
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Eoin Killackey
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Maria Long
- Division of Psychiatry, University College London, London, United Kingdom
- Department of Health Services Research and Management, City University, London, United Kingdom
| | - Joanna Moncrieff
- Division of Psychiatry, University College London, London, United Kingdom
| | - Iris Sommer
- Department of Psychiatry, University Medical Center Groningen, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - Anne Emilie Stürup
- Copenhagen Research Center for Mental Health (CORE), Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lex Wunderink
- Department of Psychiatry, University Medical Center Groningen, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - Marieke Begemann
- Department of Psychiatry, University Medical Center Groningen, Rijksuniversiteit Groningen, Groningen, The Netherlands
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5
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Hickie IB, Iorfino F, Rohleder C, Song YJC, Nichles A, Zmicerevska N, Capon W, Guastella AJ, Leweke FM, Scott J, McGorry P, Mihalopoulos C, Killackey E, Chong MK, McKenna S, Aji M, Gorban C, Crouse JJ, Koethe D, Battisti R, Hamilton B, Lo A, Hackett ML, Hermens DF, Scott EM. EMPOWERED trial: protocol for a randomised control trial of digitally supported, highly personalised and measurement-based care to improve functional outcomes in young people with mood disorders. BMJ Open 2023; 13:e072082. [PMID: 37821139 PMCID: PMC10583041 DOI: 10.1136/bmjopen-2023-072082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/08/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES Many adolescents and young adults with emerging mood disorders do not achieve substantial improvements in education, employment, or social function after receiving standard youth mental health care. We have developed a new model of care referred to as 'highly personalised and measurement-based care' (HP&MBC). HP&MBC involves repeated assessment of multidimensional domains of morbidity to enable continuous and personalised clinical decision-making. Although measurement-based care is common in medical disease management, it is not a standard practice in mental health. This clinical effectiveness trial tests whether HP&MBC, supported by continuous digital feedback, delivers better functional improvements than standard care and digital support. METHOD AND ANALYSIS This controlled implementation trial is a PROBE study (Prospective, Randomised, Open, Blinded End-point) that comprises a multisite 24-month, assessor-blinded, follow-up study of 1500 individuals aged 15-25 years who present for mental health treatment. Eligible participants will be individually randomised (1:1) to 12 months of HP&MBC or standardised clinical care. The primary outcome measure is social and occupational functioning 12 months after trial entry, assessed by the Social and Occupational Functioning Assessment Scale. Clinical and social outcomes for all participants will be monitored for a further 12 months after cessation of active care. ETHICS AND DISSEMINATION This clinical trial has been reviewed and approved by the Human Research Ethics Committee of the Sydney Local Health District (HREC Approval Number: X22-0042 & 2022/ETH00725, Protocol ID: BMC-YMH-003-2018, protocol version: V.3, 03/08/2022). Research findings will be disseminated through peer-reviewed journals, presentations at scientific conferences, and to user and advocacy groups. Participant data will be deidentified. TRIAL REGISTRATION NUMBER ACTRN12622000882729.
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Affiliation(s)
- Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Cathrin Rohleder
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alissa Nichles
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Natalia Zmicerevska
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - William Capon
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adam J Guastella
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - F Markus Leweke
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine Mannheim, Psychiatry and Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Jan Scott
- Newcastle University, Newcastle upon Tyne, UK
| | - Patrick McGorry
- Centre for Youth Mental Health, University of Melbourne Australia, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne Australia, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Min K Chong
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah McKenna
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Melissa Aji
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Carla Gorban
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dagmar Koethe
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Blake Hamilton
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- headspace Camperdown, Camperdown, New South Wales, Australia
| | - Alice Lo
- Mind Plasticity, Sydney, New South Wales, Australia
| | - Maree L Hackett
- George Institute for Global Health, Newtown, New South Wales, Australia
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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6
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Gannon L, Pearson N, Tsiglopoulos J, Mifsud N, Castagnini E, Thompson A, Langstone A, Killackey E, McGorry P, O'Donoghue B. Longitudinal study of the prevalence of sleep disorders in first episode psychosis and its clinical correlates. Schizophr Res 2023; 258:81-83. [PMID: 37523870 DOI: 10.1016/j.schres.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/09/2023] [Accepted: 07/23/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Louisa Gannon
- Department of Psychiatry, University College Dublin, Ireland; St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Nicholas Pearson
- Centre for Youth Mental Health, University of Melbourne, VIC, Australia; Orygen, 35 Poplar Rd, Parkville, VIC 3052, Australia
| | - Jonathan Tsiglopoulos
- Centre for Youth Mental Health, University of Melbourne, VIC, Australia; Orygen, 35 Poplar Rd, Parkville, VIC 3052, Australia
| | - Nathan Mifsud
- Centre for Youth Mental Health, University of Melbourne, VIC, Australia; Orygen, 35 Poplar Rd, Parkville, VIC 3052, Australia
| | - Emily Castagnini
- Centre for Youth Mental Health, University of Melbourne, VIC, Australia; Orygen, 35 Poplar Rd, Parkville, VIC 3052, Australia
| | - Andrew Thompson
- Centre for Youth Mental Health, University of Melbourne, VIC, Australia; Orygen, 35 Poplar Rd, Parkville, VIC 3052, Australia
| | - Alison Langstone
- Centre for Youth Mental Health, University of Melbourne, VIC, Australia; Orygen, 35 Poplar Rd, Parkville, VIC 3052, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, VIC, Australia; Orygen, 35 Poplar Rd, Parkville, VIC 3052, Australia
| | - Patrick McGorry
- Centre for Youth Mental Health, University of Melbourne, VIC, Australia; Orygen, 35 Poplar Rd, Parkville, VIC 3052, Australia
| | - Brian O'Donoghue
- Department of Psychiatry, University College Dublin, Ireland; St Vincent's University Hospital, Elm Park, Dublin, Ireland; Centre for Youth Mental Health, University of Melbourne, VIC, Australia; Orygen, 35 Poplar Rd, Parkville, VIC 3052, Australia; Department of Psychiatry, Royal College of Surgeons, Ireland.
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7
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Hofstad T, Nyttingnes O, Markussen S, Johnsen E, Killackey E, McDaid D, Rinaldi M, Dean K, Brinchmann B, Douglas K, Gröning L, Bjørkly S, Palmstierna T, Strømme MF, Blindheim A, Rugkåsa J, Hofmann BM, Pedersen R, Widding‐Havneraas T, Rypdal K, Mykletun A. Long term outcomes and causal modelling of compulsory inpatient and outpatient mental health care using Norwegian registry data: Protocol for a controversies in psychiatry research project. Int J Methods Psychiatr Res 2023; 33:e1980. [PMID: 37421245 PMCID: PMC10807697 DOI: 10.1002/mpr.1980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 07/10/2023] Open
Abstract
OBJECTIVES Compulsory mental health care includes compulsory hospitalisation and outpatient commitment with medication treatment without consent. Uncertain evidence of the effects of compulsory care contributes to large geographical variations and a controversy on its use. Some argue that compulsion can rarely be justified and should be reduced to an absolute minimum, while others claim compulsion can more frequently be justified. The limited evidence base has contributed to variations in care that raise issues about the quality/appropriateness of care as well as ethical concerns. To address the question whether compulsory mental health care results in superior, worse or equivalent outcomes for patients, this project will utilise registry-based longitudinal data to examine the effect of compulsory inpatient and outpatient care on multiple outcomes, including suicide and overall mortality; emergency care/injuries; crime and victimisation; and participation in the labour force and welfare dependency. METHODS By using the natural variation in health providers' preference for compulsory care as a source of quasi-randomisation we will estimate causal effects of compulsory care on short- and long-term trajectories. CONCLUSIONS This project will provide valuable insights for service providers and policy makers in facilitating high quality clinical care pathways for a high risk population group.
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Affiliation(s)
- Tore Hofstad
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
- Centre for Medical EthicsUniversity of OsloOsloNorway
| | - Olav Nyttingnes
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
- Health Services Research UnitAkershus University HospitalLørenskogNorway
| | | | - Erik Johnsen
- Division of PsychiatryHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
- NORMENTCentre of ExcellenceHaukeland University HospitalBergenNorway
| | - Eoin Killackey
- OrygenMelbourneAustralia
- Centre for Youth Mental HealthThe University of MelbourneMelbourneAustralia
| | - David McDaid
- Care Policy and Evaluation CentreDepartment of Health PolicyLondon School of Economics and Political ScienceLondonUK
| | - Miles Rinaldi
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
- Centre for Work and Mental HealthNordland Hospital TrustBodøNorway
- South West London and St George's Mental Health NHS TrustLondonUK
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental HealthSchool of Clinical MedicineUniversity of New South WalesSydneyAustralia
- Justice Health and Forensic Mental Health NetworkSydneyNSWAustralia
| | - Beate Brinchmann
- Centre for Work and Mental HealthNordland Hospital TrustBodøNorway
| | - Kevin Douglas
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
- Department of PsychologySimon Fraser UniversityVancouverBritish ColumbiaCanada
- Regional Centre for Research and Education in Forensic PsychiatryOslo University HospitalOsloNorway
| | - Linda Gröning
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
- Faculty of LawUniversity of BergenBergenNorway
| | - Stål Bjørkly
- Regional Centre for Research and Education in Forensic PsychiatryOslo University HospitalOsloNorway
- Faculty of Health and Social SciencesMolde University CollegeMoldeNorway
| | - Tom Palmstierna
- Department of Clinical NeuroscienceCentre for Psychiatric ResearchKarolinska InstitutetStockholmSweden
- Faculty of Medicine and Health SciencesDepartment of Mental HealthNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Maria Fagerbakke Strømme
- Division of PsychiatryHaukeland University HospitalBergenNorway
- NORMENTCentre of ExcellenceHaukeland University HospitalBergenNorway
| | - Anne Blindheim
- Division of PsychiatryHaukeland University HospitalBergenNorway
| | - Jorun Rugkåsa
- Health Services Research UnitAkershus University HospitalLørenskogNorway
- Centre for Care ResearchUniversity of South‐Eastern NorwayPorsgrunnNorway
- Department of Mental HealthOslo Metropolitan UniversityOsloNorway
| | - Bjørn Morten Hofmann
- Centre for Medical EthicsUniversity of OsloOsloNorway
- Faculty of Medicine and Health SciencesDepartment of Health SciencesNorwegian University of Science and TechnologyGjøvikNorway
| | | | - Tarjei Widding‐Havneraas
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
| | - Knut Rypdal
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
| | - Arnstein Mykletun
- Centre for Research and Education in Forensic PsychiatryHaukeland University HospitalBergenNorway
- Centre for Work and Mental HealthNordland Hospital TrustBodøNorway
- UiT—The Arctic University of NorwayTromsøNorway
- Division for Health ServicesNorwegian Institute of Public HealthOsloNorway
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8
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Thompson A, Fitzsimons J, Killackey E, Ahern S, Amminger P, Alvarez-Jimenez M, Berk M, Cotton S, McNeil J, McGorry P, Nelson B, O'Donoghue B, Ratheesh A, Rickwood D, Yung A, Wood S. The Australian Early Psychosis Collaborative Consortium (AEPCC): Improving Clinical Care in Early Psychosis. Australas Psychiatry 2023:10398562231174691. [PMID: 37171091 DOI: 10.1177/10398562231174691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES The field of early psychosis has undergone considerable expansion over the last few decades and has a strong evidence base of effectiveness. Like all areas of healthcare, however, early psychosis services need to more consistently deliver higher quality care to achieve better outcomes for patients and families. A national clinical research infrastructure is urgently required to enable the sector to deliver the highest quality care and expand and translate evidence more quickly and efficiently. This paper describes the establishment of the Australian Early Psychosis Collaborative Consortium (AEPCC) that aims to achieve this. CONCLUSION AEPCC is the first of its kind in Australia (and internationally). It will deliver the required clinical research infrastructure through the implementation of a clinical quality registry, clinical trials and translation network, and lived experience network. AEPCC will provide a critical resource to better understand the state of early psychosis care, and trial new interventions on a scale that has not previously been possible in Australia.
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Affiliation(s)
- Andrew Thompson
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Joanna Fitzsimons
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Paul Amminger
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael Berk
- Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Sue Cotton
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Patrick McGorry
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Barnaby Nelson
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Aswin Ratheesh
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Debra Rickwood
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alison Yung
- Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Stephen Wood
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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9
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Brown E, Killackey E, Hamilton M, Thompson A, McGorry P. Response to Allison et al. (2022) 'Headspace early intervention for psychosis in Australia: Is it still a "best buy"?'. Australas Psychiatry 2023; 31:232-233. [PMID: 36905140 DOI: 10.1177/10398562231162239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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10
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Clarke EL, Allott K, Anderson JFI, Gao CX, Filia KM, Killackey E, Cotton SM. Heterogeneity of quality of life in the later stages of first-episode psychosis recovery. Qual Life Res 2023; 32:769-780. [PMID: 36378390 PMCID: PMC9992035 DOI: 10.1007/s11136-022-03277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE First-episode psychosis (FEP) is characterised by wide heterogeneity in terms of symptom presentation and illness course. However, the heterogeneity of quality of life (QoL) in FEP is not well understood. We investigated whether subgroups can be identified using participants' responses on four QoL domains (physical health, psychological, social relationships, and environmental) 18-months into the recovery phase of FEP. We then examined the discriminant validity of these subgroups with respect to clinical, cognitive, and functioning features of FEP. METHOD Demographic and clinical characteristics, QoL, cognition, and functioning were assessed in 100 people with FEP at the 18-month follow-up of a randomised controlled trial of Individual Placement Support, which aims to facilitate vocational recovery. QoL was measured using the World Health Organisation's QoL-BRIEF. A two-stage clustering approach using Ward's method and Squared Euclidean Distance with a k-means confirmation was conducted. Multinomial logistic regressions were used to establish external validity. RESULTS Three QoL subgroups emerged: a 'good' subgroup with relatively high QoL across all domains (31%), an 'intermediate' subgroup with relatively low psychological QoL (48%) and a 'poor' subgroup with markedly low social relationship QoL (21%). Negative symptoms, depressive symptoms, social/occupational functioning, and social inclusion at follow-up predicted subgroup membership. Sensitivity analysis found similar results. CONCLUSION Although some individuals with FEP have QoL comparable to individuals without mental ill health, QoL can remain concerningly low despite treatment efforts. Future research on interventions that target factors associated with poor QoL, such as low social inclusion, is required to counteract prolonged poor QoL in FEP.
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Affiliation(s)
- E L Clarke
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - K Allott
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - J F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - C X Gao
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - K M Filia
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - E Killackey
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - S M Cotton
- , Orygen, Parkville, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
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11
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Butenko D, Rinaldi M, Brinchmann B, Brandseth OL, Killackey E, Mykletun A. The personality profile of IPS employment specialists, and how it relates to job satisfaction: A longitudinal cohort study. Scand J Psychol 2023; 64:71-79. [PMID: 35997312 PMCID: PMC10087514 DOI: 10.1111/sjop.12864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 07/03/2022] [Accepted: 08/01/2022] [Indexed: 01/11/2023]
Abstract
The role of the Individual Placement and Support (IPS) employment specialist is a new type of occupation within mental healthcare. High turnover among employment specialists necessitates improvement in their recruitment and retention. One element that impacts retention is job satisfaction. We assessed the personality of 38 employment specialists (Big 5 Inventory-2) and measured job satisfaction over three time periods. Compared to norm data, employment specialists were significantly higher on Extraversion (ΔT = 8.0, CI: 5.59-10.42), Agreeableness (ΔT = 7.8, CI: 5.56-10.12), Conscientiousness (ΔT = 3.3, CI: 0.8-5.84), Open-mindedness (ΔT = 3.5, CI: 0.97-6.07), while lower on Negative emotionality (ΔT = -3.5, CI: -6.5 to -0.42). Extraversion had a substantial longitudinal positive effect on job satisfaction (β at T1 = 0.39; CI: 0.10-0.73) (β at T2 = 0.40; CI: 0.03-0.80), while Negative emotionality - a substantial negative effect (β at T1 = -0.60; CI: -0.90 to -0.30) (β at T2 = -0.50; CI: -0.90 to -0.12). Male gender was significantly associated with higher job satisfaction at the time point 1 (β = -0.46; CI: -0.80 to -0.14). Age, length of employment in the role, Agreeableness, Conscientiousness and Open-mindedness were not found to have substantial significant effects on job satisfaction of employment specialists. Recruiting employment specialists who score high on Extraversion and low on Negative emotionality may be a good fit for the role and job satisfaction.
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Affiliation(s)
- Daniil Butenko
- Centre for work and mental health, Nordland Hospital trust, Bodø, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University in Bergen, Bergen, Norway
| | - Miles Rinaldi
- Centre for work and mental health, Nordland Hospital trust, Bodø, Norway.,South West London and St George's Mental Health NHS Trust, London, UK
| | - Beate Brinchmann
- Centre for work and mental health, Nordland Hospital trust, Bodø, Norway.,UiT The Arctic University of Norway, Tromsø, Norway
| | - Oda Lekve Brandseth
- Centre for work and mental health, Nordland Hospital trust, Bodø, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Eoin Killackey
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Arnstein Mykletun
- Centre for work and mental health, Nordland Hospital trust, Bodø, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway.,UiT The Arctic University of Norway, Tromsø, Norway.,Norwegian Institute of Public Health, Oslo, Norway
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12
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Brown E, Castagnini E, Langstone A, Mifsud N, Gao C, McGorry P, Killackey E, O'Donoghue B. High-risk sexual behaviours in young people experiencing a first episode of psychosis. Early Interv Psychiatry 2023; 17:159-166. [PMID: 35355426 DOI: 10.1111/eip.13301] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
AIM The sexual health of adults with schizophrenia is poorer than the general population; however, less is known about young people experiencing a first episode of psychosis (FEP). The aim of this study was to explore the high-risk sexual behaviours and sexual well-being indicators of a cohort of young people with FEP. METHODS Data collected from young people (15-24 years) with FEP attending the EPPIC service in Melbourne and participating in a physical health intervention were analysed. Baseline trial data collected on sexual health and high-risk behaviours, psychiatric symptomology, functioning, and substance use are presented by gender. Associations between symptomology and functioning with sexual behaviour are explored. RESULTS A total of 69 young people were included in this study; mean age was 19.6 years (SD±2.8), 53.6% were male, 59.6% identified as heterosexual, and 21.7% were currently in a relationship. Within the cohort, 78.3% had ever been sexually active. Of these, 44.2% consistently used a condom at last sex act and 35.7% used barrier contraception consistently, 22.5% had previously been pregnant, and 18.6% had tested positive for an STI. Finally, young people were more likely to have been sexually active if they were currently using substances. CONCLUSIONS These findings suggest that high rates of high-risk sexual behaviour remain an issue for young people experiencing a first episode of psychosis. Promoting sexual well-being and communication skills between sexual partners should be targeted to ensure that high-risk sexual health outcomes are mitigated as early as possible.
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Affiliation(s)
- Ellie Brown
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Emily Castagnini
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Alison Langstone
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Nathan Mifsud
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Caroline Gao
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Patrick McGorry
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Eoin Killackey
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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13
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Pehlivan N, Brown E, Sanchez AYA, McMillan F, Moore D, Bhaduri A, Monson K, Badcock P, Thompson K, Killackey E, Chanen A, O'Donoghue B. What impact does illness severity have on the sexual health of young people affected by mental health disorders? A comparison of inpatients and outpatients. Australas Psychiatry 2022; 30:705-711. [PMID: 33118366 DOI: 10.1177/1039856220960373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Young people affected by mental health disorders have greater sexual health needs compared to their peers. Less is known about this need across illness severity. METHOD A cross-sectional survey of the sexual health of those attending outpatients or inpatients within a youth mental health service was conducted. Statistical differences between groups were explored. RESULTS One hundred and seven young people (18-25 years) participated and of these, 37.7% were inpatients who had more severe psychiatric symptoms than outpatients. While inpatients were as likely to be sexually active as outpatients, they were significantly less likely to have a regular sexual partner (25% vs 64.5%). Additionally, they used amphetamines more frequently during sex (28.6% vs 5.8%). Sexual dysfunction was experienced by 55.6% of inpatients and 37.9% of outpatients. CONCLUSIONS High-risk sexual behaviours and sexual dysfunction were highly prevalent in both groups. For some behaviours and dysfunction, this prevalence was higher in the inpatient population. Holistic clinical services that address the mental, physical and sexual health needs of consumers are needed both within inpatient and outpatient settings.
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Affiliation(s)
| | - Ellie Brown
- Orygen, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
| | | | | | - Danielle Moore
- Orygen, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
| | | | | | - Paul Badcock
- Centre for Youth Mental Health, University of Melbourne, Australia
| | | | - Eoin Killackey
- Orygen, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
| | - Andrew Chanen
- Orygen, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
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14
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O'Donoghue B, Mifsud N, Castagnini E, Langstone A, Thompson A, Killackey E, McGorry P. A single-blind, randomised controlled trial of a physical health nurse intervention to prevent weight gain and metabolic complications in first-episode psychosis: the Physical Health Assistance in Early Psychosis (PHAstER) study. BJPsych Open 2022; 8:e189. [PMID: 36254811 PMCID: PMC9634606 DOI: 10.1192/bjo.2022.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Factors that contribute to the early mortality observed in psychotic disorders, specifically obesity, smoking and sedentary behaviour, occur early in the disorder. AIMS We aimed to determine whether the integration of a physical health nurse in the care of young people with first-episode psychosis could prevent clinically significant weight gain (≥7% body weight). Secondary outcomes included rates of smoking, metabolic syndrome and sedentary behaviour. METHOD In this single-blind, randomised controlled trial, participants who had received under 4 weeks of antipsychotic medication were randomly allocated to either the intervention (addition of a physical health nurse to their care) or treatment as usual (TAU) for 12 weeks. RESULTS Of the 77 participants, there were follow-up data for 86.8% (n = 33) of the intervention group and 82.1% (n = 32) of the TAU group. After 12 weeks, 27.3% of the intervention group experienced clinically significant weight gain compared with 34.4% of the TAU group (odds ratio 0.72, 95% CI 0.25-2.06, P = 0.54). After 6 months, 40.7% of the intervention group gained clinically significant weight compared with 44.1% of the TAU group (P = 0.79). There was no difference in mean change in weight between groups after 12 weeks (2.6 kg v. 2.9 kg, P = 0.87) or 6 months (3.6 kg v. 4.3 kg, P = 0.64). There were no differences in the rates of tobacco smoking cessation, prevalence of metabolic syndrome or physical activity levels. CONCLUSIONS This intervention failed to prevent the metabolic complications that are highly prevalent in psychotic disorders in the short to medium term, indicating that more intensive interventions are required.
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Affiliation(s)
- Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Australia; Early Psychosis Prevention and Intervention Centre, Orygen, Australia; and Department of Psychiatry, St Vincent's University Hospital, Ireland
| | - Nathan Mifsud
- Centre for Youth Mental Health, University of Melbourne, Australia; and Early Psychosis Prevention and Intervention Centre, Orygen, Australia
| | - Emily Castagnini
- Centre for Youth Mental Health, University of Melbourne, Australia; and Early Psychosis Prevention and Intervention Centre, Orygen, Australia
| | - Alison Langstone
- Centre for Youth Mental Health, University of Melbourne, Australia; and Early Psychosis Prevention and Intervention Centre, Orygen, Australia
| | - Andrew Thompson
- Centre for Youth Mental Health, University of Melbourne, Australia; and Early Psychosis Prevention and Intervention Centre, Orygen, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, Australia; and Early Psychosis Prevention and Intervention Centre, Orygen, Australia
| | - Patrick McGorry
- Centre for Youth Mental Health, University of Melbourne, Australia; and Early Psychosis Prevention and Intervention Centre, Orygen, Australia
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15
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Butenko D, Rinaldi M, Brinchmann B, Killackey E, Johnsen E, Mykletun A. Turnover of IPS employment specialists: Rates and predictors. JVR 2022. [DOI: 10.3233/jvr-221195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: There are anecdotal reports of high job turnover of Individual Placement and Support employment specialists. However, no studies have addressed this issue. OBJECTIVE: To explore whether turnover rates among employment specialists are higher compared to public sector employees along with the correlates of turnover intentions. METHODS: A repeated cross-sectional study collected data from 40 employment specialists in Norway using validated scales to measure job perceptions. Turnover intentions were the main outcome. RESULTS: Turnover rate of employment specialists (45.0%) was significantly higher than the average turnover rate of other occupations in the public sector (27.1%) in the same geographical regions (x2 = 6.5, df = 1, p = 0.01). After adjusting for potential confounders, five factors remained significantly and associated with turnover intentions in directions as expected: general job satisfaction (β= –0.33, p < 0.05), satisfaction with current work (β= –0.35, p < 0.05), satisfaction with supervision (β= –0.28, p < 0.05), work meaningfulness (β= –0.42, p < 0.05) and Negative emotionality personality trait (β= 0.58, p < 0.05). CONCLUSIONS: Addressing turnover will positively impact on productivity and job satisfaction of employment specialists along with continuity of employment support for people with mental health conditions.
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Affiliation(s)
- Daniil Butenko
- Centre for Work and Mental Health, Nordland Hospital Trust, Bod, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Miles Rinaldi
- Centre for Work and Mental Health, Nordland Hospital Trust, Bod, Norway
- South West London and St George’s Mental Health NHS Trust, London, UK
| | - Beate Brinchmann
- Centre for Work and Mental Health, Nordland Hospital Trust, Bod, Norway
| | - Eoin Killackey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Arnstein Mykletun
- Centre for Work and Mental Health, Nordland Hospital Trust, Bod, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- UiT The Arctic University of Norway, Troms, Norway
- Norwegian Institute of Public Health, Oslo, Norway
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16
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Amminger GP, Lin A, Kerr M, Weller A, Spark J, Pugh C, O'Callaghan S, Berger M, Clark SR, Scott JG, Baker A, McGregor I, Cotter D, Sarnyai Z, Thompson A, Yung AR, O'Donoghue B, Killackey E, Mihalopoulos C, Yuen HP, Nelson B, McGorry PD. Cannabidiol for at risk for psychosis youth: A randomized controlled trial. Early Interv Psychiatry 2022; 16:419-432. [PMID: 34190422 DOI: 10.1111/eip.13182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND No biological treatment has been firmly established for the at-risk stage of psychotic disorder. In this study we aim to test if subthreshold psychotic symptoms can be effectively treated with cannabidiol (CBD), a non-psychoactive compound of the plant Cannabis sativa. The question has taken on increased importance in the wake of evidence questioning both the need and efficacy of specific pharmacological interventions in the ultra-high risk (UHR) for psychosis group. METHODS Three-arm randomized controlled trial of 405 patients (135 per arm) aged 12-25 years who meet UHR for psychosis criteria. The study includes a 6-week lead-in phase during which 10% of UHR individuals are expected to experience symptom remission. Participants will receive CBD (per oral) at doses 600 or 1000 mg per day (fixed schedule) for 12 weeks. Participants in the third arm of the trial will receive matching placebo capsules. Primary outcome is severity of positive psychotic symptoms as measured by the Comprehensive Assessment of At-Risk Mental States at 12 weeks. We hypothesize that CBD will be significantly more effective than placebo in improving positive psychotic symptoms in UHR patients. All participants will also be followed up 6 months post baseline to evaluate if treatment effects are sustained. CONCLUSION This paper reports on the rationale and protocol of the Cannabidiol for At Risk for psychosis Youth (CanARY) study. This study will test CBD for the first time in the UHR phase of psychotic disorder.
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Affiliation(s)
- G Paul Amminger
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Melissa Kerr
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Amber Weller
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Jessica Spark
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Charlotte Pugh
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Sally O'Callaghan
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Maximus Berger
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Scott R Clark
- Discipline of Psychiatry, University of Adelaide, Adelaide, Australia
| | - James G Scott
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, Australia.,Metro North Mental Health Service, Herston, Australia
| | - Andrea Baker
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, Australia
| | - Iain McGregor
- Lambert Initiative for Cannabinoid Therapeutics, University of Sydney, Sydney, Australia
| | | | | | - Andrew Thompson
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Alison R Yung
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,School of Health Science, University of Manchester, Manchester, UK
| | - Brian O'Donoghue
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Eoin Killackey
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | | | - Hok Pan Yuen
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Barnaby Nelson
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Patrick D McGorry
- Orygen, Melbourne, Australia.,The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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17
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Park AL, Rinaldi M, Brinchmann B, Killackey E, Aars NAP, Mykletun A, McDaid D. Economic analyses of supported employment programmes for people with mental health conditions: A systematic review. Eur Psychiatry 2022; 65:e51. [PMID: 35983840 PMCID: PMC9491084 DOI: 10.1192/j.eurpsy.2022.2309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Abstract
Background
Employment is intrinsic to recovery from mental health conditions, helping people live independently. Systematic reviews indicate supported employment (SE) focused on competitive employment, including individual placement and support (IPS), is effective in helping people with mental health conditions into work. Evidence is limited on cost-effectiveness. We comprehensively reviewed evidence on the economic case for SE/IPS programmes.
Methods
We searched PubMed/MEDLINE, EMBASE, PsycINFO, CINAHL, IBSS, Business Source Complete, and EconLit for economic and return on investment analyses of SE/IPS programmes for mental health conditions. Traditional vocational rehabilitation, sheltered work, and return to work initiatives after sickness absence of less than 1 year were excluded. Studies were independently screened by two reviewers. We assessed quality using the Consolidate Health Economic Evaluation Reporting Standards checklist. The protocol was preregistered with PROSPERO-CRD42020184359.
Results
From 40,015 references, 28 studies examined the economic case for IPS, four IPS augmented by another intervention, and 24 other forms of SE. Studies were very heterogenous, quality was variable. Of 41 studies with quality scores over 50%, 10 reported cost per quality-adjusted life year gained, (8 favourable to SE/IPS), 14 net monetary benefits (12 positive), 5 return on investment (4 positive), and 20 cost per employment outcome (14 favorable, 5 inconclusive, 1 negative). Totally, 24 of these 41 studies had monetary benefits that more than outweighed the additional costs of SE/IPS programmes.
Conclusions
There is a strong economic case for the implementation of SE/IPS programmes. The economic case is conservative as evidence on long-term impacts of programmes is limited.
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18
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Liao Z, Allott K, Anderson JFI, Killackey E, Cotton SM. Quality of life in first episode psychosis: a cluster analytic approach. Qual Life Res 2021; 31:1807-1817. [PMID: 34661805 DOI: 10.1007/s11136-021-03014-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Quality of life is increasingly recognised as an important outcome for young people with first episode psychosis (FEP). The first aim was to determine whether distinct homogenous subgroups of young people with FEP could be delineated based on profiles on quality of life domains (Physical Health, Psychological, Social relationships and Environmental). The second aim was to examine the discriminant validity of these subgroups with respect to demographic, functioning and clinical features of FEP. METHOD Quality of life, demographic characteristics, clinical characteristics, cognition and functioning were assessed in 145 people with FEP. Cluster analysis using Ward's methods and Squared Euclidean Distance with a k-means verification were employed to identify subgroups with homogenous quality of life profiles. The clusters were externally validated using multinomial logistic regressions. RESULTS Three distinct quality of life profiles were identified: one with good quality of life across all domains (30%), one with poor quality of life particularly in Psychological and Social relationships domains (28%), and one 'intermediate' group with comparatively low Psychological quality of life (42%). Depression, semantic verbal fluency, social inclusion and social/occupational functioning showed associations with group membership. CONCLUSION Our results suggest the potential of maintaining relatively good quality of life despite the experience of FEP. Future research on interventions to improve quality of life may consider the potential of addressing depression, social inclusion and social/occupational functioning.
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Affiliation(s)
- Z Liao
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - K Allott
- Orygen, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Melbourne, VIC, 3052, Australia
| | - J F I Anderson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - E Killackey
- Orygen, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Melbourne, VIC, 3052, Australia
| | - S M Cotton
- Orygen, Parkville, Melbourne, VIC, 3052, Australia. .,Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10 (35 Poplar Road), Parkville, Melbourne, VIC, 3052, Australia.
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19
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O'Donoghue B, Castagnini E, Langstone A, Mifsud N, Thompson A, Killackey E, McGorry P. Sedentary behaviour in young people presenting with a first episode of psychosis before and during the covid-19 pandemic restrictions. Schizophr Res 2021; 233:31-33. [PMID: 34225024 DOI: 10.1016/j.schres.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/11/2021] [Accepted: 06/18/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Brian O'Donoghue
- Orygen, 35 Poplar rd, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, University of Melbourne, Victoria, Australia; St Vincents University Hospital, Elm Park, Dublin 4, Ireland.
| | - Emily Castagnini
- Orygen, 35 Poplar rd, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Alison Langstone
- Orygen, 35 Poplar rd, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Nathan Mifsud
- Orygen, 35 Poplar rd, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Andrew Thompson
- Orygen, 35 Poplar rd, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Eoin Killackey
- Orygen, 35 Poplar rd, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
| | - Patrick McGorry
- Orygen, 35 Poplar rd, Parkville, VIC 3052, Australia; Centre for Youth Mental Health, University of Melbourne, Victoria, Australia
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20
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Alvarez-Jimenez M, Koval P, Schmaal L, Bendall S, O'Sullivan S, Cagliarini D, D'Alfonso S, Rice S, Valentine L, Penn DL, Miles C, Russon P, Phillips J, McEnery C, Lederman R, Killackey E, Mihalopoulos C, Gonzalez-Blanch C, Gilbertson T, Lal S, Cotton SM, Herrman H, McGorry PD, Gleeson JFM. The Horyzons project: a randomized controlled trial of a novel online social therapy to maintain treatment effects from specialist first-episode psychosis services. World Psychiatry 2021; 20:233-243. [PMID: 34002511 PMCID: PMC8129860 DOI: 10.1002/wps.20858] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study aimed to determine whether, following two years of specialized support for first-episode psychosis, the addition of a new digital intervention (Horyzons) to treatment as usual (TAU) for 18 months was more effective than 18 months of TAU alone. We conducted a single-blind randomized controlled trial. Participants were people with first-episode psychosis (N=170), aged 16-27 years, in clinical remission and nearing discharge from a specialized service. They were randomly assigned (1:1) to receive Horyzons plus TAU (N=86) or TAU alone (N=84) between October 2013 and January 2017. Horyzons is a novel, comprehensive digital platform merging: peer-to-peer social networking; theory-driven and evidence-informed therapeutic interventions targeting social functioning, vocational recovery and relapse prevention; expert clinician and vocational support; and peer support and moderation. TAU involved transfer to primary or tertiary community mental health services. The primary outcome was social functioning at 18 months as measured by the Personal and Social Performance Scale (PSP). Forty-seven participants (55.5%) in the Horyzons plus TAU group logged on for at least 6 months, and 40 (47.0%) for at least 9 months. Social functioning remained high and stable in both groups from baseline to 18-month follow-up, with no evidence of significant between-group differences (PSP mean difference: -0.29, 95% CI: -4.20 to 3.63, p=0.77). Participants in the Horyzons group had a 5.5 times greater increase in their odds to find employment or enroll in education compared with those in TAU (odds ratio, OR=5.55, 95% CI: 1.09-28.23, p=0.04), with evidence of a dose-response effect. Moreover, participants in TAU were twice as likely to visit emergency services compared to those in the Horyzons group (39% vs. 19%; OR=0.31, 95% CI: 0.11-0.86, p=0.03, number needed to treat, NNT=5). There was a non-significant trend for lower hospitalizations due to psychosis in the Horyzons group vs. TAU (13% vs. 27%; OR=0.36, 95% CI: 0.11-1.08, p=0.07, NNT=7). So, although we did not find a significant effect of Horyzons on social functioning compared with TAU, the intervention was effective in improving vocational or educational attainment, a core component of social recovery, and in reducing usage of hospital emergency services, a key aim of specialized first-episode psychosis services. Horyzons holds significant promise as an engaging and sustainable intervention to provide effective vocational and relapse prevention support for young people with first-episode psychosis beyond specialist services.
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Affiliation(s)
- Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Koval
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Lianne Schmaal
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sarah Bendall
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shaunagh O'Sullivan
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Daniela Cagliarini
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Simon D'Alfonso
- Orygen, Parkville, VIC, Australia
- School of Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Simon Rice
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lee Valentine
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Chris Miles
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Penni Russon
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jessica Phillips
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Carla McEnery
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Reeva Lederman
- School of Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin Health Economics, Deakin University, Geelong, VIC, Australia
| | - Cesar Gonzalez-Blanch
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- University Hospital Marques de Valdecilla-IDIVAL, Santander, Spain
| | - Tamsyn Gilbertson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sue Maree Cotton
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Helen Herrman
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Patrick D McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - John F M Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Allott K, Van‐der‐el K, Bryce S, Hamilton M, Adams S, Burgat L, Killackey E, Rickwood D. Need for clinical neuropsychological assessment in headspace youth mental health services: A national survey of providers. Australian Journal of Psychology 2020. [DOI: 10.1111/ajpy.12225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia,
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,
| | - Kristi Van‐der‐el
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia,
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,
| | - Shayden Bryce
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia,
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,
| | - Matthew Hamilton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia,
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,
| | - Sophie Adams
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia,
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,
- Orygen Youth Health, Parkville, Victoria, Australia,
| | - Liz Burgat
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia,
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia,
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia,
| | - Debra Rickwood
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia,
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23
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Phillips L, Gleeson J, Killackey E. A clinician's quick guide of evidence‐based approaches: Psychotic disorders. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - John Gleeson
- Australian Catholic University, Melbourne, Australia,
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24
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Liddicoat S, Badcock P, Killackey E. Principles for designing the built environment of mental health services. Lancet Psychiatry 2020; 7:915-920. [PMID: 32171432 DOI: 10.1016/s2215-0366(20)30038-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 10/24/2022]
Abstract
Although there is an increasing amount of literature on the key principles for the design of mental health services, the contribution of the built environment to outcomes for the service user is a largely neglected area. To help address this gap, we present evidence that highlights the pivotal role of evidence-based architectural design in service users' experience of mental health services. We propose six important design principles to enhance the care of mental health service users. Drawing on research into the delivery of mental health services and best-practice approaches to their architectural design, we outline a holistic conceptual model for designing mental health services that enhance treatment outcomes and experiences, provide benefits to families and the community, and promote community resilience. In this Personal View, we argue that the design of mental health services needs to extend across disciplinary boundaries to integrate evidence-informed practice across individual, interpersonal, and community levels.
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Affiliation(s)
- Stephanie Liddicoat
- School of Design, Faculty of Health, Arts and Design, Swinburne University, Melbourne, VIC, Australia.
| | - Paul Badcock
- Centre of Youth Mental Health, The University of Melbourne, Orygen, Melbourne, VIC, Australia; Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre of Youth Mental Health, The University of Melbourne, Orygen, Melbourne, VIC, Australia
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25
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O'Donoghue B, Mifsud NG, Tindall RM, Foote L, Hartmann JA, Obst K, Simmons MB, McGorry PD, Killackey E. Physical health assistance in early recovery of psychosis: Study protocol for a randomized controlled trial. Early Interv Psychiatry 2020; 14:587-593. [PMID: 31643142 DOI: 10.1111/eip.12884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/22/2019] [Indexed: 12/14/2022]
Abstract
AIM Young people with psychotic disorders have poorer physical health compared to their healthy peers, a state compounded by the metabolic side-effects of antipsychotic medications. To address this, Orygen Youth Health has introduced physical health services including exercise physiologists and dieticians. These services are typically coordinated by the case manager and doctor. It is not yet known whether a treating team member dedicated to physical health will improve engagement, adherence and outcomes with these services. Hence, the protocol is presented here for a trial to evaluate the effect of including a physical health nurse in the care of young people with first-episode psychosis. METHODS This will be a single-blind randomized controlled trial that includes 15- to 24-year-olds with first-episode psychosis who have just commenced (within 30 days) antipsychotic medication. The primary outcome will be the event of clinically significant weight gain (≥7% body weight). Participants will be assigned either a physical health nurse in their treating team (in addition to the case manager and doctor) for a 12-week period, or treatment as usual (case manager and doctor). Research assessments will be conducted at baseline, 12 and 26 weeks. Activity trackers worn by participants for the study's duration will measure sleep and physical activity. CONCLUSION The present study will determine whether a physical health nurse will facilitate participants in attending and engaging in physical health interventions and whether this will be associated with physical health improvements or the prevention of worsening physical health.
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Affiliation(s)
- Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Mental Health Service, Orygen Youth Health, Parkville, Australia
| | - Nathan G Mifsud
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Rachel M Tindall
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Lauren Foote
- Mental Health Service, Orygen Youth Health, Parkville, Australia
| | - Jessica A Hartmann
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Kate Obst
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Magenta B Simmons
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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26
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Chanen A, Yung A, Killackey E, Hickie I, Coghill D, Scott JG, Scott E, Denborough P, Dixon L, Fisher L, Kane J, Malla A, Nordentoft M, Pellen D, Radovini A, McGorry P. The value of early intervention in creating the new mental health system: Response to Allison et al. Aust N Z J Psychiatry 2020; 54:667-669. [PMID: 32466664 DOI: 10.1177/0004867420925169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew Chanen
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Alison Yung
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Eoin Killackey
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ian Hickie
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - David Coghill
- Departments of Paediatrics and Psychiatry, Murdoch Children's Research Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - James G Scott
- Metro North Mental Health Service, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Elizabeth Scott
- Youth Mental Health Team, Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Paul Denborough
- Alfred Child & Youth Mental Health Service, Melbourne, VIC, Australia
| | - Lisa Dixon
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Leeanne Fisher
- Child & Youth Mental Health Service, Austin Health, Heidelberg, VIC, Australia
| | - John Kane
- Departments of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital, New York, NY, USA
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP) and ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Merete Nordentoft
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Pellen
- Nepean Child and Youth Mental Health Service, Penrith, NSW, Australia
| | - Alessandra Radovini
- Mindful - Centre for Training and Research in Developmental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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27
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Allott K, van-der-EL K, Bryce S, Parrish EM, McGurk SR, Hetrick S, Bowie CR, Kidd S, Hamilton M, Killackey E, Velligan D. Compensatory Interventions for Cognitive Impairments in Psychosis: A Systematic Review and Meta-Analysis. Schizophr Bull 2020; 46:869-883. [PMID: 32052837 PMCID: PMC7345816 DOI: 10.1093/schbul/sbz134] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Cognitive compensatory interventions aim to alleviate psychosocial disability by targeting functioning directly using aids and strategies, thereby minimizing the impact of cognitive impairment. The aim was to conduct a systematic review and meta-analysis of cognitive compensatory interventions for psychosis by examining the effects on functioning and symptoms, and exploring whether intervention factors, study design, and age influenced effect sizes. METHODS Electronic databases (Ovid Medline, PsychINFO) were searched up to October 2018. Records obtained through electronic and manual searches were screened independently by two reviewers according to selection criteria. Data were extracted to calculate estimated effects (Hedge's g) of treatment on functioning and symptoms at post-intervention and follow-up. Study quality was assessed using Cochrane Collaboration's risk of bias tool. RESULTS Twenty-six studies, from 25 independent randomized controlled trials (RCTs) were included in the meta-analysis (1654 participants, mean age = 38.9 years, 64% male). Meta-analysis revealed a medium effect of compensatory interventions on functioning compared to control conditions (Hedge's g = 0.46, 95% CI = 0.33, 0.60, P < .001), with evidence of relative durability at follow-up (Hedge's g = 0.36, 95% CI = 0.19, 0.54, P < .001). Analysis also revealed small significant effects of cognitive compensatory treatment on negative, positive, and general psychiatric symptoms, but not depressive symptoms. Estimated effects did not significantly vary according to treatment factors (ie, compensatory approach, dosage), delivery method (ie, individual/group), age, or risk of bias. Longer treatment length was associated with larger effect sizes for functioning outcomes. No evidence of publication bias was identified. CONCLUSION Cognitive compensatory interventions are associated with robust, durable improvements in functioning in people with psychotic illnesses.
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Affiliation(s)
- Kelly Allott
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia,To whom correspondence should be addressed; 35 Poplar Road, Parkville, VIC, 3052, Australia; tel: +3 9966 9423, e-mail:
| | - Kristi van-der-EL
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Shayden Bryce
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Emma M Parrish
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, CA
| | - Susan R McGurk
- Department of Occupational Therapy, Center for Psychiatric Rehabilitation, Boston University, Boston, MA
| | - Sarah Hetrick
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia,Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | | | - Sean Kidd
- Department of Psychiatry, University of Toronto, Toronto, Ontario, ON, Canada
| | - Matthew Hamilton
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Eoin Killackey
- Orygen, Parkville, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Dawn Velligan
- Department of Psychiatry, University of Texas Health Science Centre, San Antonio, TX
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Chanen AM, Nicol K, Betts JK, Bond GR, Mihalopoulos C, Jackson HJ, Thompson KN, Jovev M, Yuen HP, Chinnery G, Ring J, Allott K, McCutcheon L, Salmon AP, Killackey E. INdividual Vocational and Educational Support Trial (INVEST) for young people with borderline personality disorder: study protocol for a randomised controlled trial. Trials 2020; 21:583. [PMID: 32591007 PMCID: PMC7320570 DOI: 10.1186/s13063-020-04471-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/30/2020] [Indexed: 12/14/2022] Open
Abstract
Background The clinical onset of borderline personality disorder (BPD) usually occurs in young people (aged 12–25 years) and commonly leads to difficulty achieving and maintaining vocational (education and/or employment) engagement. While current psychosocial interventions lead to improvements in psychopathology, they have little effect upon functioning. Individual Placement and Support (IPS) is a client-driven model that assists individuals with severe mental illness to engage with education and/or employment appropriate to their personal goals, and that provides ongoing support to maintain this engagement. The objective of the INdividual Vocational and Educational Support Trial (INVEST) is to evaluate the effectiveness of adding IPS to an evidence-based early intervention programme for BPD, with the aim of improving vocational outcomes. Methods/design INVEST is a single-blind, parallel-groups, randomised controlled trial (RCT). The randomisation is stratified by gender and age and uses random permuted blocks. The interventions are 39 weeks of either IPS, or ‘usual vocational services’ (UVS). Participants will comprise 108 help-seeking young people (aged 15–25 years) with three or more DSM-5 BPD features and a desire to study or work, recruited from the Helping Young People Early (HYPE) early intervention programme for BPD at Orygen, in Melbourne, Australia. All participants will receive the HYPE intervention. After baseline assessment, staff who are blind to the intervention group allocation will conduct assessments at 13, 26, 39 and 52 weeks. At the 52-week primary endpoint, the primary outcome is the number of days in mainstream education/employment since baseline. Secondary outcomes include the cost-effectiveness of the intervention, quality of life, and BPD severity. Discussion Current treatments for BPD have little impact on vocational outcomes and enduring functional impairment is prevalent among this patient group. IPS is a targeted functional intervention, which has proven effective in improving vocational outcomes for adults and young people with psychotic disorders. This trial will investigate whether IPS is effective for improving vocational (employment and educational) outcomes among young people with subthreshold or full-syndrome BPD. Trial registration Australian New Zealand Clinical Trials Registry, ID: ACTRN12619001220156. 13 September 2019.
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Affiliation(s)
- Andrew M Chanen
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia. .,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.
| | - Katie Nicol
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Jennifer K Betts
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Gary R Bond
- IPS Employment Center, Rockville Institute and Westat Inc., 85 Mechanic Street, Suite C3-1, Box 4A, Lebanon, NH, 03766, USA
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, VIC, 3220, Australia
| | - Henry J Jackson
- Melbourne School of Psychological Sciences, Redmond Barry Building, The University of Melbourne, Parkville, Melbourne, VIC, 3010, Australia
| | - Katherine N Thompson
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Martina Jovev
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Hok Pan Yuen
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Gina Chinnery
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Judith Ring
- Travancore School, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Kelly Allott
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Louise McCutcheon
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Ashleigh P Salmon
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
| | - Eoin Killackey
- Orygen, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Melbourne, VIC, 3052, Australia
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Delagneau G, Bowden SC, Bryce S, van-der-El K, Hamilton M, Adams S, Burgat L, Killackey E, Rickwood D, Allott K. Thematic analysis of youth mental health providers' perceptions of neuropsychological assessment services. Early Interv Psychiatry 2020; 14:220-227. [PMID: 31512388 DOI: 10.1111/eip.12876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/09/2019] [Accepted: 08/25/2019] [Indexed: 01/18/2023]
Abstract
AIM A growing number of quantitative studies have investigated the utility of neuropsychological assessment in mental health settings. However, to the best of our knowledge, no previous study has qualitatively explored youth mental health providers' perceptions of neuropsychological assessment services. A more in-depth understanding of the perceived advantages and barriers associated with neuropsychological assessment in youth mental health settings is critical to better inform policy, practice and service uptake. Thus, the aim of this study was to qualitatively explore clinicians' views about neuropsychological assessments for youth with mental health concerns. METHODS A single open-ended qualitative question, included as part of an anonymous cross-sectional online survey, was completed by clinicians (N = 206) treating or assessing adolescents and young adults within Australian primary care mental health centres (headspace). Responses were analysed using an inductive approach to thematic analysis. RESULTS Five main themes were identified. Clinicians (a) identified barriers to accessing neuropsychological assessments (53%), (b) indicated a range of mixed outcomes following neuropsychological assessment (39%), (c) highlighted a need for neuropsychological assessments (22%), (d) reported a lack of awareness about this resource (10%) and (e) described practice issues associated with neuropsychological services (4%). CONCLUSION This study uncovered perceived factors contributing to reduced access to neuropsychological assessment in Australian youth mental health settings. Given potential adverse outcomes resulting from this clinical service gap, efforts should be made to address factors contributing to poorer access, thereby mitigating the impact of poor access on the management of mental illness in youth. Several strategies, including funding neuropsychological assessments, are discussed.
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Affiliation(s)
- Garance Delagneau
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Stephen C Bowden
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Shayden Bryce
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Kristi van-der-El
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Matthew Hamilton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Sophie Adams
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
| | - Liz Burgat
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Debra Rickwood
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia & headspace The National Youth Mental Health Foundation, Melbourne, Australia
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
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30
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Waghorn G, Killackey E, Dickson P, Brock L, Skate C. Evidence-based supported employment for people with psychiatric disabilities in Australia: Progress in the past 15 years. Psychiatr Rehabil J 2020; 43:32-39. [PMID: 31204823 DOI: 10.1037/prj0000370] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This report summarizes the major developments in Australia since the first introduction of Individual Placement and Support (IPS) in 2005 in order to outline the current situation and discuss future challenges and opportunities. METHOD Using an informal snowball sampling method, all those known to be involved in IPS implementations in Australia in the last 5 years were contacted. RESULTS The program has expanded from 2 full-time employment specialists in 2005 to 87.6 in 2018. The expansion has been most promising in youth mental health where an initial national 14-site trial of IPS was recently expanded to 24 sites. If the trial is successful, IPS may become a core component of a national youth mental health initiative. Expansion in the adult community mental health sector has been constrained by several factors including the low priority for rehabilitation in the public mental health system. On the positive side, the availability of independent technical support from Western Australia means that all new IPS sites can receive expert technical support for program implementation, continuing high-fidelity delivery, external fidelity assessment, outcome evaluation, and cohort-based outcome reporting. CONCLUSION AND IMPLICATIONS FOR PRACTICE The expansion of IPS in the public funded adult mental health sector has not kept pace with progress in the youth mental health sector. There is an urgent need for adult mental health services to cease excluding vocational rehabilitation from treatment, care, and recovery plans. Disability Employment Service contract managers could increase disincentives for providers to adopt high caseloads and low intensity services, at the expense of more intensive evidence-based practices. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville
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31
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Brinchmann B, Widding-Havneraas T, Modini M, Rinaldi M, Moe CF, McDaid D, Park AL, Killackey E, Harvey SB, Mykletun A. A meta-regression of the impact of policy on the efficacy of individual placement and support. Acta Psychiatr Scand 2020; 141:206-220. [PMID: 31733146 DOI: 10.1111/acps.13129] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Individual placement and support (IPS) has shown consistently better outcomes on competitive employment for patients with severe mental illness than traditional vocational rehabilitation. The evidence for efficacy originates from few countries, and generalization to different countries has been questioned. This has delayed implementation of IPS and led to requests for country-specific RCTs. This meta-analysis examines if evidence for IPS efficacy can be generalized between rather different countries. METHODS A systematic search was conducted according to PRISMA guidelines to identify RCTs. Overall efficacy was established by meta-analysis. The generalizability of IPS efficacy between countries was analysed by random-effects meta-regression, employing country- and date-specific contextual data obtained from the OECD and the World Bank. RESULTS The systematic review identified 27 RCTs. Employment rates are more than doubled in IPS compared with standard vocational rehabilitation (RR 2.07 95% CI 1.82-2.35). The efficacy of IPS was marginally moderated by strong legal protection against dismissals. It was not moderated by regulation of temporary employment, generosity of disability benefits, type of integration policies, GDP, unemployment rate or employment rate for those with low education. CONCLUSIONS The evidence for efficacy of IPS is very strong. The efficacy of IPS can be generalized between countries.
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Affiliation(s)
- B Brinchmann
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,UiT - The Arctic University of Norway, Tromsø, Norway
| | - T Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry and Psychology, Haukeland University Hospital, Bergen, Norway
| | - M Modini
- School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Concord Centre for Mental Health, NSW Health, Sydney, NSW, Australia
| | - M Rinaldi
- South West London & St George's Mental Health NHS Trust, London, UK
| | - C F Moe
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - D McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A-L Park
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - E Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic, Australia
| | - S B Harvey
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - A Mykletun
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,UiT - The Arctic University of Norway, Tromsø, Norway.,Centre for Research and Education in Forensic Psychiatry and Psychology, Haukeland University Hospital, Bergen, Norway.,Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
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32
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Turley D, Drake R, Killackey E, Yung AR. Perceived stress and psychosis: The effect of perceived stress on psychotic-like experiences in a community sample of adolescents. Early Interv Psychiatry 2019; 13:1465-1469. [PMID: 30712294 DOI: 10.1111/eip.12795] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/08/2019] [Accepted: 01/13/2019] [Indexed: 11/29/2022]
Abstract
AIMS Psychotic-like experiences (PLE) are sub-threshold, non-clinical forms of psychosis which can place an individual at greater risk of development of a psychotic disorder. Subtypes of PLE have also been shown to exist (bizarre experiences, persecutory ideation, perceptual abnormalities and magical thinking). Perceived stress relates to how two individuals may deal with the same objectively stressful event in different ways. The objective of our study was to investigate the extent to which perceived stress is associated with PLE in a community sample of adolescents, whether certain subtypes of PLE correlate more with perceived stress than others and to explore the role of depression with these associations. METHODS A total of 655 students completed the community assessment of psychic experiences (CAPE) and perceived stress scale (PSS). Pearson's correlation was used to investigate the relationship between PSS and CAPE and also between perceived stress and the four subtypes of PLE. Regression then explored the effect of perceived stress on PLE when accounting for depressive symptomatology. RESULTS Positive correlation was found between PSS and total CAPE (r = 0.405, P = 0.000). Positive significant correlation was also found between PSS and each subtype of PLE, with persecutory ideation correlating the strongest and magical thinking the least. Perceived stress was significantly associated with PLE even after adjusting for depression. CONCLUSIONS We recommend that more regular screening of perceived stress in adolescent populations could lead to earlier recognition of PLE. Early treatment has shown to reduce rates of transition to psychosis, and so could benefit our adolescent community in the future.
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Affiliation(s)
- Dan Turley
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Drake
- School of Community Based Medicine, The University of Manchester, Manchester, UK
| | - Eoin Killackey
- Orygen, The National Centre for Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Alison R Yung
- Divison of Psychology and Mental Health, School of Heath Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Firth J, Rosenbaum S, Galletly C, Siddiqi N, Stubbs B, Killackey E, Koyanagi A, Siskind D. Protecting physical health in people with mental illness - Authors' reply. Lancet Psychiatry 2019; 6:890-891. [PMID: 31631867 DOI: 10.1016/s2215-0366(19)30387-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 08/30/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW 2145, Australia; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cherrie Galletly
- Northern Adelaide Local Health Network, Adelaide, SA, Australia; Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia; Ramsey Health Services Mental Health, SA, Australia
| | - Najma Siddiqi
- Health Sciences, University of York, Hull York Medical School, Bradford, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, Australia
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Grierson AB, Scott J, Glozier N, Hickie IB, Amminger PG, Killackey E, McGorry PD, Pantelis C, Phillips L, Scott E, Yung AR, Purcell R. Can youth at high risk of illness progression be identified by measures of rumination and sleep-wake disturbance. Early Interv Psychiatry 2019; 13:1214-1219. [PMID: 30485651 DOI: 10.1111/eip.12757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 04/09/2018] [Accepted: 10/17/2018] [Indexed: 02/05/2023]
Abstract
AIM Clinical staging models offer a useful framework for understanding illness trajectories, where individuals are located on a continuum of illness progression from stage 0 (at-risk but asymptomatic) to stage 4 (end-stage disease). Importantly, clinical staging allows investigation of risk factors for illness progression with the potential to target trans-diagnostic mechanisms at an early stage, especially in help-seeking youth who often present with sub-threshold syndromes. While depressive symptoms, rumination and sleep-wake disturbances may worsen syndrome outcomes, the role of these related phenomena has yet to be examined as risk factors for trans-diagnostic illness progression in at-risk youth. METHODS This study is a prospective follow-up of 248 individuals aged 12 to 25 years presenting to headspace services with sub-threshold syndromes (stage 1) classified under the clinical staging model to determine transition to threshold syndromes (stage 2). Factor analysis of depression, rumination and sleep-wake patterns was used to identify key dimensions and any associations between factors and transition to stage 2 at follow-up. RESULTS At 1 year, 9% of cases met criteria for stage 2 (n = 22). One of three identified factors, namely the factor reflecting the commonalities shared between rumination and sleep-wake disturbance, significantly differentiated cases that transitioned to stage 2 vs those that did not demonstrate transition. Items loading onto this factor, labelled Anergia, included depression severity and aspects of rumination and sleep-wake disturbance that were characterized as introceptive. CONCLUSIONS Common dimensions between rumination and sleep-wake disturbance present a detectable trans-diagnostic marker of illness progression in youth, and may represent a target for early intervention.
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Affiliation(s)
- Ashlee B Grierson
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Jan Scott
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia.,Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Nick Glozier
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul G Amminger
- 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
| | - Eoin Killackey
- 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
| | - Patrick D McGorry
- 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
| | - Christos Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Lisa Phillips
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Scott
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia.,School of Medicine, Notre Dame University, Sydney, New South Wales, Australia
| | - Alison R Yung
- Division of Psychology and Mental Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rosemary Purcell
- 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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Moe C, Brinchmann B, McDaid D, Killackey E, Rinaldi M, Mykletun A. Approaches to implementing individual placement and support in the health and welfare sectors: a scoping review protocol. JBI Evid Synth 2019; 18:170-177. [PMID: 31503087 DOI: 10.11124/jbisrir-d-19-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to identify and map existing knowledge on the methods and approaches used to implement Individual Placement and Support at scale in the health and welfare sectors, as well as the frameworks and methodological approaches used in implementation studies, and to identify knowledge gaps that are important for further research. INTRODUCTION Individual Placement and Support is an evidence-based, standardized approach designed to support people with mental health conditions to gain and maintain competitive jobs in the labor market. Translating scientific knowledge into mainstream practice is challenging, and there is insufficient knowledge of the approaches used to implement Individual Placement and Support at scale in the health and welfare sectors. INCLUSION CRITERIA This review will include studies reporting on the implementation of Individual Placement and Support for people with mental health conditions within a health and welfare context, from 1993 to the present. Studies that have abstracts in English, German or Scandinavian languages will be considered. Randomized controlled trials will be excluded. METHODS The review will be conducted in accordance with the JBI methodology for scoping reviews. We will follow a three-step search strategy to trace published studies. Search strategies are developed to fit with the databases MEDLINE, Cochrane Central Register of Controlled Trials, Embase, PsycINFO, Base, OpenGrey and CINAHL. Data will be extracted from papers included in the review using data extraction tables developed by the reviewers. A qualitative content analysis will be used to facilitate the mapping of the results.
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Affiliation(s)
- Cathrine Moe
- Nord University, Faculty of Nursing and Health Sciences, Bodø, Norway.,Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway
| | - Beate Brinchmann
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway
| | - David McDaid
- London School of Economics and Political Science, Personal Social Services Research Unit, Department of Health Policy, London, UK
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Miles Rinaldi
- South West London and St George's Mental Health NHS Trust, London, UK
| | - Arnstein Mykletun
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway
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Abstract
AIMS Social inclusion is increasingly understood to have positive and beneficial implications for the mental health outcomes of people with severe mental illness. The concept is plagued by definitional inconsistencies and a lack of consensus regarding what it means to be socially included, in particular for groups most vulnerable to social exclusion, such as people with mental illness. The aim of this study was to obtain a consensus regarding the key contributors to social inclusion from the perspective of people with and without a lived experience of mental illness (consumers of mental health services, carers, and general community members). METHODS Delphi methodology was employed to reach consensus agreement. The Delphi questionnaire was based on a previous review of the literature and consisted of 147 items categorized into 13 domains. It was presented to participants over three rounds. Participants (N = 104) were recruited into three groups (32 consumers, 32 carers of people with a mental illness, and 40 members of the general community - neither consumers nor carers). Retention of participants from Round 1 to Round 3 was 79.8%. RESULTS Similarities and differences were observed between the groups. A number of items were very strongly endorsed as key contributors to social inclusion, relating to social participation, social supports, housing, neighbourhood, community involvement, employment and education, health and well-being and service utilization. CONCLUSION Findings supported previous work, indicating the importance of having a strong sense of connection with others as well as the importance of safe and stable housing, support services and personal motivation and hope. We obtained a well-rounded perspective among groups regarding the key contributors to social inclusion, with a particular relevance to people living with mental illness. This perspective has significant clinical and research utility.
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Affiliation(s)
- Kate Filia
- 1 Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,2 Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Henry Jackson
- 3 Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Sue Cotton
- 1 Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,2 Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Eoin Killackey
- 1 Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,2 Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Caneo C, Carney R, Carvalho AF, Chatterton ML, Correll CU, Curtis J, Gaughran F, Heald A, Hoare E, Jackson SE, Kisely S, Lovell K, Maj M, McGorry PD, Mihalopoulos C, Myles H, O'Donoghue B, Pillinger T, Sarris J, Schuch FB, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale SB, Thornicroft G, Torous J, Usherwood T, Vancampfort D, Veronese N, Ward PB, Yung AR, Killackey E, Stubbs B. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6:675-712. [PMID: 31324560 DOI: 10.1016/s2215-0366(19)30132-4] [Citation(s) in RCA: 693] [Impact Index Per Article: 138.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Najma Siddiqi
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cherrie Galletly
- Ramsay Health Care Mental Health, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia; Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Constanza Caneo
- Departamento de Psiquiatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rebekah Carney
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andre F Carvalho
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Christoph U Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jackie Curtis
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adrian Heald
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - Erin Hoare
- Food and Mood Centre, Deakin University, Melbourne, VIC, Australia
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Patrick D McGorry
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Hannah Myles
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Toby Pillinger
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Medical Research Council London Institute of Medical Sciences, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; The Melbourne Clinic, Melbourne, VIC, Australia
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - David Shiers
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marco Solmi
- Neurosciences Department and Padua Neuroscience Centre, University of Padua, Padua, Italy
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Johanna Taylor
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK
| | - Scott B Teasdale
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of General Practice, Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Philip B Ward
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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38
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Caruana E, Allott K, Farhall J, Parrish EM, Davey CG, Chanen AM, Killackey E, Cotton SM. Factors associated with vocational disengagement among young people entering mental health treatment. Early Interv Psychiatry 2019; 13:961-968. [PMID: 30019851 DOI: 10.1111/eip.12718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 06/12/2018] [Accepted: 06/19/2018] [Indexed: 11/27/2022]
Abstract
AIM Most mental disorders have their onset by age 25, disrupting normative vocational engagement. Factors associated with vocational disengagement at first contact with specialist treatment are important for service planning. The aim of this paper was to investigate the association between theoretically important factors and vocational disengagement for youth entering mental health treatment. METHODS A file audit was used to extract vocational data of 145 young people aged 15 to 25 years entering treatment in 2011 at a public youth mental health service in Melbourne, Australia. Comparisons were made across three specialist programs for: psychosis (n = 50), mood disorders (n = 52) and borderline personality pathology (n = 43). Individual characteristics were entered into univariate and multivariate logistic regressions to investigate their associations with vocational disengagement. RESULTS Educational disengagement was associated with being older (OR = 4.38, P = 0.004) and not living with parents (OR = 2.87, P = 0.038). Unemployment and being NEET (Not in Education, Employment or Training) were both associated with not having commenced tertiary education (OR = 0.23, P = 0.022; OR = 0.05, P = 0.002; respectively). Being NEET was also associated with being older (OR = 6.18, P = 0.004). Primary diagnostic grouping was not associated with vocational disengagement, once accounting for other factors. CONCLUSIONS The likelihood of vocational disengagement did not differ across disorder groups, implying that intervention should be "transdiagnostic" and might best target education first, specifically post-secondary qualifications. Other domains or variables not measured in this study are also likely to be important, and this might include young people's support systems and symptom severity. Qualitative studies may be useful for exploring further factors relevant to vocational engagement.
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Affiliation(s)
- Emma Caruana
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria
| | - Kelly Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria.,North Western Mental Health, Parkville, Victoria
| | - Emma M Parrish
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria.,Northeastern University, Boston, Massachusetts
| | - Christopher G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria.,Orygen Youth Health, Parkville, Victoria
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria.,North Western Mental Health, Parkville, Victoria.,Orygen Youth Health, Parkville, Victoria
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria
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39
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Adan Sanchez AY, McMillan E, Bhaduri A, Pehlivan N, Monson K, Badcock P, Thompson K, Killackey E, Chanen A, O'Donoghue B. High-risk sexual behaviour in young people with mental health disorders. Early Interv Psychiatry 2019; 13:867-873. [PMID: 29920952 DOI: 10.1111/eip.12688] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/21/2018] [Accepted: 05/16/2018] [Indexed: 11/27/2022]
Abstract
AIM This study aimed to determine the prevalence of high-risk sexual behaviours, sequelae and associated factors in young people attending a youth mental health service. METHODS The study design was a cross-sectional survey of 103 young people aged between 15-25 years carried out across four specialist mental health clinics. A questionnaire on the sexual health of secondary level students was adapted for this study. Mental health symptomatology was assessed through the Brief Psychiatric Rating Scale (BPRS). RESULTS The mean age was 20.9 (SD ±2.8) years, with 50.5% being female, 41.7% male and 7.7% transgender. A total of 52.4% (N = 54) attended the psychosis [EPPIC] clinic; 15.6% (N = 16) attended the ultra-high risk for psychosis [PACE] clinic; 19.4% (N = 20) attended the personality disorders [HYPE] clinic; and 12.6% (N = 13) attended the mood clinic [YMC]. The mean BPRS score was 47.7 (SD ±12.2). A total of 77.7% of young people had previously been sexually active and of these, 37.5% did not use consistent contraception; 26.3% had been pregnant, of which 95.2% were unplanned. A total of 68.8% reported having been tested for sexually transmitted infections and 25.5% tested positive. The severity of symptoms or clinical characteristics were not associated with engagement in high-risk sexual behaviours. CONCLUSIONS These results indicate that young people with mental health disorders have high needs in regard to their sexual health, which could be addressed by incorporating sexual health referral pathways into early intervention services.
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Affiliation(s)
- Asiel Yair Adan Sanchez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth McMillan
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Amit Bhaduri
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
| | | | | | - Paul Badcock
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for 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 for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
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40
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Delagneau G, Bowden SC, van-der-El K, Bryce S, Hamilton M, Adams S, Burgat L, Killackey E, Rickwood D, Allott K. Perceived need for neuropsychological assessment according to geographic location: A survey of Australian youth mental health clinicians. Appl Neuropsychol Child 2019; 10:123-132. [PMID: 31303056 DOI: 10.1080/21622965.2019.1624170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Recent studies have shown that neuropsychological assessment is a scarce resource in youth mental health settings. The need for neuropsychological assessment might differ in metropolitan and nonmetropolitan areas due to characteristics inherent to these different regions. However, no formal studies have investigated this question. The aim of this research was to investigate whether need for neuropsychological assessment in youth mental health settings varies by geographic location. A cross-sectional online survey was completed by clinicians (N = 532) treating or assessing adolescents and young adults attending Australian primary care mental health (headspace) centers. Results indicated a similar need for neuropsychological assessment across the geographic areas. However, neuropsychological assessment was significantly less available to clients in outer regional, remote and very remote areas compared to major cities. Exploratory analyses further revealed that there were significantly fewer clinicians with a postgraduate degree and more clinicians with a bachelor degree in outer regional, remote and very remote areas than in major cities. Given the negative impact of cognitive impairments in youth with a mental illness, these findings reveal a necessity to enhance the availability and access to neuropsychological assessment in rural settings. Several plausible avenues to achieving increased access include increasing the funding available for this resource; providing nonmetropolitan clinicians with sufficient neuropsychological consultation, including rural training and rotations in neuropsychologists' postgraduate training; and exploring the use of tele-health in the provision of neuropsychological assessments in nonmetropolitan settings.
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Affiliation(s)
- Garance Delagneau
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Stephen C Bowden
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Kristi van-der-El
- Orygen, The National centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Shayden Bryce
- Orygen, The National centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Matthew Hamilton
- Orygen, The National centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Sophie Adams
- Orygen, The National centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen Youth Health, Parkville, Australia
| | - Liz Burgat
- Orygen, The National centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Eoin Killackey
- Orygen, The National centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Debra Rickwood
- Headspace National Youth Mental Health Foundation, Melbourne, Australia.,Faculty of Health, University of Canberra, ACT, Australia
| | - Kelly Allott
- Orygen, The National centre of Excellence in Youth Mental Health, Parkville, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
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41
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Caruana E, Farhall J, Cotton SM, Parrish E, van-der-El K, Davey CG, Chanen AM, Bryce SD, Killackey E, Allott K. Vocational engagement among young people entering mental health treatment compared with their general population peers. Early Interv Psychiatry 2019; 13:692-696. [PMID: 29968285 DOI: 10.1111/eip.12712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/23/2018] [Accepted: 06/10/2018] [Indexed: 11/26/2022]
Abstract
AIM To compare rates of vocational engagement for youth entering specialist mental health treatment with the general population. METHODS A file audit retrieved vocational data for 145 youth aged 15 to 25 entering treatment. Clinical and population data were stratified by age and sex and compared between cohorts. RESULTS Compared to the population, young people entering mental health treatment were less likely to have completed at least Year 11 in school (77% vs 42%, P < 0.001); and demonstrated higher rates of "Not in Education, Employment or Training" (9% vs 33%, P < 0.001). Individuals aged 15 to 18 years entering treatment experienced greater rates of educational disengagement than the population (30% vs 11%, P < 0.001), whereas people aged 19 to 25 years showed higher unemployment rates (52% vs 35%, P = 0.003). CONCLUSIONS Youth entering specialist mental health treatment have marked levels of vocational disengagement compared to demographically-matched peers. Early vocational intervention for these young people is essential.
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Affiliation(s)
- Emma Caruana
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Bundoora, Victoria, Australia.,North Western Mental Health, Parkville, Victoria, Australia
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Emma Parrish
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kristi van-der-El
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Christopher G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Orygen Youth Health, Parkville, Victoria, Australia
| | - Shayden D Bryce
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia.,Monash School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, 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, Parkville, Australia
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42
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Osman H, Jorm AF, Killackey E, Francey S, Mulcahy D. Early psychosis workforce development: Core competencies for mental health professionals working in the early psychosis field. Early Interv Psychiatry 2019; 13:217-223. [PMID: 28792114 DOI: 10.1111/eip.12465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 05/17/2017] [Accepted: 06/17/2017] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to identify the core competencies required of mental health professionals working in the early psychosis field, which could function as an evidence-based tool to support the early psychosis workforce and in turn assist early psychosis service implementation and strengthen early psychosis model fidelity. METHOD The Delphi method was used to establish expert consensus on the core competencies. In the first stage, a systematic literature search was conducted to generate competency items. In the second stage, a panel consisting of expert early psychosis clinicians from around the world was formed. Panel members then rated each of the competency items on how essential they are to the clinical practice of all early psychosis clinicians. RESULTS In total, 1023 pieces of literature including textbooks, journal articles and grey literature were reviewed. A final 542 competency items were identified for inclusion in the questionnaire. A total of 63 early psychosis experts participated in 3 rating rounds. Of the 542 competency items, 242 were endorsed as the required core competencies. There were 29 competency items that were endorsed by 62 or more experts, and these may be considered the foundational competencies for early psychosis practice. CONCLUSION The study generated a set of core competencies that provide a common language for early psychosis clinicians across professional disciplines and country of practice, and potentially are a useful professional resource to support early psychosis workforce development and service reform.
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Affiliation(s)
- Helen Osman
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Alfred Hospital Psychiatric Services, Melbourne, Victoria, Australia.,International Early Psychosis Association, Melbourne, Victoria, Australia
| | - Anthony F Jorm
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Eoin Killackey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Alfred Hospital Psychiatric Services, Melbourne, Victoria, Australia
| | - Shona Francey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Dianne Mulcahy
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Victoria, Australia
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43
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Alvarez-Jimenez M, Bendall S, Koval P, Rice S, Cagliarini D, Valentine L, D’Alfonso S, Miles C, Russon P, Penn DL, Phillips J, Lederman R, Wadley G, Killackey E, Santesteban-Echarri O, Mihalopoulos C, Herrman H, Gonzalez-Blanch C, Gilbertson T, Lal S, Chambers R, Daglas-Georgiou R, Latorre C, Cotton SM, McGorry PD, Gleeson JF. HORYZONS trial: protocol for a randomised controlled trial of a moderated online social therapy to maintain treatment effects from first-episode psychosis services. BMJ Open 2019; 9:e024104. [PMID: 30782893 PMCID: PMC6368148 DOI: 10.1136/bmjopen-2018-024104] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Specialised early intervention services have demonstrated improved outcomes in first-episode psychosis (FEP); however, clinical gains may not be sustained after patients are transferred to regular care. Moreover, many patients with FEP remain socially isolated with poor functional outcomes. To address this, our multidisciplinary team has developed a moderated online social media therapy (HORYZONS) designed to enhance social functioning and maintain clinical gains from specialist FEP services. HORYZONS merges: (1) peer-to-peer social networking; (2) tailored therapeutic interventions; (3) expert and peer-moderation; and (4) new models of psychological therapy (strengths and mindfulness-based interventions) targeting social functioning. The aim of this trial is to determine whether following 2 years of specialised support and 18-month online social media-based intervention (HORYZONS) is superior to 18 months of regular care. METHODS AND ANALYSIS This study is a single-blind randomised controlled trial. The treatment conditions include HORYZONS plus treatment as usual (TAU) or TAU alone. We recruited 170 young people with FEP, aged 16-27 years, in clinical remission and nearing discharge from Early Psychosis Prevention and Intervention Centre, Melbourne. The study includes four assessment time points, namely, baseline, 6-month, 12-month and 18-month follow-up. The study is due for completion in July 2018 and included a 40-month recruitment period and an 18-month treatment phase. The primary outcome is social functioning at 18 months. Secondary outcome measures include rate of hospital admissions, cost-effectiveness, vocational status, depression, social support, loneliness, self-esteem, self-efficacy, anxiety, psychological well-being, satisfaction with life, quality of life, positive and negative psychotic symptoms and substance use. Social functioning will be also assessed in real time through our Smartphone Ecological Momentary Assessment tool. ETHICS AND DISSEMINATION Melbourne Health Human Research Ethics Committee (2013.146) provided ethics approval for this study. Findings will be made available through scientific journals and forums and to the public via social media and the Orygen website. TRIAL REGISTRATION NUMBER ACTRN12614000009617; Pre-results.
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Affiliation(s)
- Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Sarah Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter Koval
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Simon Rice
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Daniela Cagliarini
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Lee Valentine
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Simon D’Alfonso
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Christopher Miles
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Penni Russon
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - David L Penn
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
- Department of Psychology, University of North Carolina Chapel Hill, NC, United Stated
| | - Jess Phillips
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Reeva Lederman
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Greg Wadley
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Olga Santesteban-Echarri
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Calgary, Alberta, Canada
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Helen Herrman
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Tamsyn Gilbertson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
- University of Montreal Hospital Research Center, Health Innovation and Evaluation Hub, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | | | - Rothanthi Daglas-Georgiou
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Sue M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - John F Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
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44
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Bardell-Williams M, Eaton S, Downey L, Bowtell M, Thien K, Ratheesh A, Killackey E, McGorry P, O'Donoghue B. Rates, determinants and outcomes associated with the use of community treatment orders in young people experiencing first episode psychosis. Int J Law Psychiatry 2019; 62:85-89. [PMID: 30616858 DOI: 10.1016/j.ijlp.2018.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/31/2018] [Accepted: 11/24/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Community treatment orders (CTOs) are a controversial form of involuntary treatment for individuals affected by mental health disorders and yet little is known about the use of CTOs in first presentations. Therefore, this study aimed to determine the rates, determinants and outcomes associated with the use of CTOs in young people with a first episode of psychosis (FEP). METHODS This epidemiological cohort study included all individuals aged 15-24 who presented with a FEP to the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne between 01.01.2011 and 31.12.13. RESULTS A total of 544 young people presented with a FEP during the study period and of these, 93 (17.3%) were subject to a CTO during their episode of care. A total of 69.7% of CTOs were commenced after the first three months of treatment and the median duration of CTOs was 168.5 days. Males, a diagnosis of a schizophrenia spectrum disorder and a concurrent substance abuse disorder were associated with the use of CTOs. Additionally, young people with more severe positive psychotic symptoms were more likely to be subject to a CTO. At the time of discharge, only 38.7% of those subject to a CTO were in education or employment compared to 65.4% of those who had not been subject to a CTO. CONCLUSIONS The majority of CTOs are commenced after at least three months of treatment, however the optimal timing of CTO implementation needs to be determined. The poor functioning of young people on a CTO should be the focus of future interventional studies.
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Affiliation(s)
- Melissa Bardell-Williams
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Scott Eaton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Linglee Downey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Meghan Bowtell
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Kristen Thien
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Aswin Ratheesh
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Orygen Youth Health, 35 Poplar Rd, Parkville, Melbourne, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Brian O'Donoghue
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Rd, Parkville, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Orygen Youth Health, 35 Poplar Rd, Parkville, Melbourne, Australia.
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45
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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46
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Hayes L, Brophy L, Harvey C, Tellez JJ, Herrman H, Killackey E. Enabling choice, recovery and participation: evidence-based early intervention support for psychosocial disability in the National Disability Insurance Scheme. Australas Psychiatry 2018; 26:578-585. [PMID: 29457477 DOI: 10.1177/1039856218759407] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES: The aim of this study was to identify the most effective interventions for early intervention in psychosocial disability in the National Disability Insurance Scheme (NDIS) through an evidence review. METHODS: A series of rapid reviews were undertaken to establish possible interventions for psychosocial disability, to develop our understanding of early intervention criteria for the NDIS and to determine which interventions would meet these criteria. RESULTS: Three interventions (social skills training, supported employment and supported housing) have a strong evidence base for effectiveness in early intervention in people with psychosocial disability, with the potential for adoption by the NDIS. They support personal choice and recovery outcomes. Illness self-management, cognitive remediation and cognitive behavioural therapy for psychosis demonstrate outcomes to mitigate impairment. The evidence for family psycho-education is also very strong. CONCLUSIONS: This review identified evidence-based, recovery-oriented approaches to early intervention in psychosocial disability. They meet the criteria for early intervention in the NDIS, are relevant to participants and consider their preferences. Early intervention has the potential to save costs by reducing participant reliance on the scheme.
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Affiliation(s)
- Laura Hayes
- Research Specialist, Parenting Research Centre, Melbourne, VIC, Australia
| | - Lisa Brophy
- Associate Professor, Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, and; Principal Research Fellow, Mind Australia Limited, Melbourne, VIC, Australia
| | - Carol Harvey
- Professor, Department of Psychiatry, The University of Melbourne, VIC, and; Consultant Psychiatrist, North West Area Mental Health Service, Coburg, VIC, Australia
| | - Juan Jose Tellez
- Research Assistant, Graduate School of Education, Melbourne Social Equity Institute, The University of Melbourne, Melbourne, VIC, Australia
| | - Helen Herrman
- Professor, Orygen, National Centre of Excellence in Youth Mental Health, Parkville, VIC, and; Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Associate Director, Orygen, National Centre of Excellence in Youth Mental Health, Parkville, VIC, and; Graduate Research and Education Head, Functional Recovery in Youth Mental Health, Melbourne, Melbourne, VIC, Australia
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47
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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48
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Alvarez-Jimenez M, Gleeson JF, Bendall S, Penn DL, Yung AR, Ryan RM, Eleftheriadis D, D'Alfonso S, Rice S, Miles C, Russon P, Lederman R, Chambers R, Gonzalez-Blanch C, Lim MH, Killackey E, McGorry PD, Nelson B. Enhancing social functioning in young people at Ultra High Risk (UHR) for psychosis: A pilot study of a novel strengths and mindfulness-based online social therapy. Schizophr Res 2018; 202:369-377. [PMID: 30031616 DOI: 10.1016/j.schres.2018.07.022] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/28/2018] [Accepted: 07/06/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Psychological and pharmacological treatments have been shown to reduce rates of transition to psychosis in Ultra High Risk (UHR) young people. However, social functioning deficits have been unresponsive to current treatments. AIMS The study aims were to: i) describe the theoretical basis and therapeutic targets of a novel intervention targeting social functioning in UHR young people; and ii) examine its acceptability, safety and preliminary effect on social functioning. METHODS An international, multidisciplinary team developed a new intervention (MOMENTUM) to improve social functioning in UHR young people. MOMENTUM blends two novel approaches to social recovery: strengths and mindfulness-based intervention embedded within a social media environment, and application of the self-determination theory of motivation. The acceptability and safety of MOMENTUM were tested through a 2-month pilot study with 14 UHR participants. RESULTS System usage was high, with over 70% of users being actively engaged over the trial. All participants reported a positive experience using MOMENTUM, considered it safe and would recommend it to others. 93% reported it to be helpful. There were large, reliable improvements in social functioning (d = 1.83, p < 0.001) and subjective wellbeing (d = 0.75, p = 0.03) at follow-up. There were significant increases in the mechanisms targeted by the intervention including strengths usage (d = 0.70, p = 0.03), mindfulness skills (d = 0.66, p = 0.04) and components of social support. Social functioning improvement was significantly correlated with indicators of system usage. CONCLUSION MOMENTUM is engaging and safe. MOMENTUM appeared to engage the hypothesized mechanisms and showed promise as a new avenue to improve social functioning in UHR young people.
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Affiliation(s)
- M Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia.
| | - J F Gleeson
- School of Psychology, Australian Catholic University, Melbourne, Australia
| | - S Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - D L Penn
- School of Psychology, Australian Catholic University, Melbourne, Australia; University of North Carolina Chapel Hill, USA
| | - A R Yung
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - R M Ryan
- Australian Catholic University, Institute for Positive Psychology and Education, Australia; University of Rochester, Meliora Hall, Rochester, NY, United States
| | - D Eleftheriadis
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - S D'Alfonso
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; The School of Computing and Information Systems, The University of Melbourne, Australia
| | - S Rice
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - C Miles
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - P Russon
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - R Lederman
- The School of Computing and Information Systems, The University of Melbourne, Australia
| | | | | | - M H Lim
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Australia
| | - E Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - P D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - B Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
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49
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Chisholm KE, Wigman JTW, Hallett D, Woodall T, Mahfouda S, Reniers RLEP, Killackey E, Yung AR, Wood SJ, Lin A. The role of coping in the association between subclinical psychotic experiences and functioning: A within study replication in two independent adolescent samples. Schizophr Res 2018; 201:91-97. [PMID: 29885966 DOI: 10.1016/j.schres.2018.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/09/2018] [Accepted: 05/13/2018] [Indexed: 11/16/2022]
Abstract
An inverse association between psychosocial functioning and psychotic experiences is now established in both clinical and non-clinical populations, however the mechanisms which drive this are unclear. Adolescents with subclinical psychotic experiences (SPE) are more likely to use maladaptive coping strategies and less likely to use adaptive ones, and maladaptive coping has also been associated with poor functioning. A within study replication in two adolescent samples from the general populations of Melbourne, Australia (n = 723) and Birmingham, United Kingdom (n = 239), was conducted to determine whether the association between SPE and psychosocial functioning is mediated by coping style. SPE were associated with reduced general and family functioning and to a lesser extent with reduced peer functioning. Task-oriented (focusing on solving the problem) and emotion-oriented (negative emotional responses) coping were found to mediate the relationship between SPE and three types of functioning in both the Melbourne and the Birmingham samples. The within study replication consistently found that coping style mediates SPE and psychosocial functioning, despite significant differences in age, gender, functioning, use of coping styles, and level of SPE between the two samples. Longitudinal research is needed to fully understand any causal role coping may play in the relationship between SPE and poor functioning. The results have important public health and clinical implications, and suggest that techniques which increase levels of adaptive coping and reduce levels of maladaptive coping (in particular emotion-oriented styles) may help to break the cycle between SPE, functional decline, and eventual need for care.
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Affiliation(s)
- Katharine E Chisholm
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | - Johanna T W Wigman
- University of Groningen, University Medical Center Groningen, Dept. of Psychiatry, ICPE, The Netherlands
| | - Danielle Hallett
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Tamara Woodall
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Simone Mahfouda
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Renate L E P Reniers
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Alison R Yung
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Stephen J Wood
- Institute for Mental Health, School of Psychology, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
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50
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Caruana E, Cotton SM, Farhall J, Parrish EM, Chanen A, Davey CG, Killackey E, Allott K. A Comparison of Vocational Engagement Among Young People with Psychosis, Depression and Borderline Personality Pathology. Community Ment Health J 2018; 54:831-841. [PMID: 29159496 DOI: 10.1007/s10597-017-0197-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 11/04/2017] [Indexed: 12/13/2022]
Abstract
Poor vocational engagement is well documented among young people experiencing first-episode psychosis (FEP). The aim of the present study was to establish and compare rates of vocational engagement across young people with first-episode psychosis, depression, and borderline personality pathology. A file audit was used to collect vocational data of young people aged 15-25 entering tertiary mental health treatment in 2011. Rates of vocational engagement were similar across groups, indicating that like those with FEP, young people with depression and borderline personality pathology experience impaired vocational engagement and are in need of targeted vocational interventions. Post hoc analysis indicated that that the depression group had significantly more people who were partially vocationally engaged compared with the psychosis group, suggesting that vocational interventions might need to be targeted differently across different diagnostic groups. Future research should explore risk factors for vocational disengagement across diagnostic groups in order to inform intervention development.
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Affiliation(s)
- E Caruana
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia. .,La Trobe University, Bundoora, VIC, 3083, Australia.
| | - S M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - J Farhall
- La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.,North Western Mental Health, Parkville, VIC, Australia
| | - E M Parrish
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - A Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,North Western Mental Health, Parkville, VIC, Australia.,Orygen Youth Health, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - C G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia.,Orygen Youth Health, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - E Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - K Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia
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