(Cd,Mg)Te crystals for picosecond-response optical-to-x-ray radiation detectors

We demonstrate a photodetector sensitive to both optical and x-ray picosecond pulses based on our in-house grown cadmium magnesium telluride (Cd,Mg)Te single crystal. Specifically, we developed In-doped Cd_0.96Mg_0.04Te material and discuss its femtosecond optical photoresponse, as well as the detector performance, such as <100-pA dark current and up to 0.22-mA/W responsivity for 780-nm wavelength optical radiation. The detector exposed to Ti fluorescence (K alpha) x-ray pulses at 4.5 keV, generated by a free-electron laser beam with the central energy of 9.8 keV and <100 fs pulse width, exhibited readout-electronics-limited 200-ps full-width-at-half-maximum photoresponse, demonstrating that it is suitable for coarse timing in free-electron laser x-ray/optical femtosecond pump-probe spectroscopy applications.

Long-term impact of a mental health literacy resource applied by regular classroom teachers in a Canadian school cohort

Application of evidence-based mental health literacy (MHL) curriculum resources by classroom teachers has been demonstrated to significantly improve knowledge and decrease stigma in the short term.

AIMS

To report results that extend these positive findings for a period of one year.

METHOD

In a naturalistic cohort study, 332 grade 9 students (ages 14-15) in a Canadian school district learned from an evidence-based curriculum resource (the Guide) applied by classroom teachers who trained in its use. Evaluations of knowledge and stigma were conducted before the Guide, immediately following the Guide delivery and at one-year follow-up.

RESULTS

Students showed significant (p < .001) and substantial (d = 0.68 and 0.67) short-term and significant (p < .001) and substantial (d = 0.44 and 0.58) long-term improvements in knowledge and reductions in stigma. Significant stigma reduction was found among female students than male students, but no gender differences on knowledge were found at long-term follow-up. Educators showed significant and substantial short-term improvements in knowledge (p < .001; d = 1.03) and reductions in stigma (p < .05; d = 0.35).

CONCLUSIONS

The Guide resource delivered by trained classroom teachers may have value in enhancing MHL outcomes for young people.

The Impact of Transitions, a Mental Health Literacy Intervention With Embedded Life Skills for Postsecondary Students: Preliminary Findings From a Naturalistic Cohort Study

OBJECTIVE

Mental illness is a common medical condition to onset during adolescence. Young people who leave for postsecondary life are at an especially challenging period of lifetime when many will leave home and familiar environments for prolonged periods of time. These new circumstances may put young people at risk of developing mental health problems or disorders or exacerbate existing mental disorders. Alternatively, some young people may misinterpret the normal negative emotional states occurring as a result of these new challenges as a mental disorder requiring professional intervention. We conducted a quasiexperimental cohort study to investigate the effectiveness of a mental health literacy intervention Transitions with blended life skills to address these challenges for first-year postsecondary students.

METHODS

Students (n = 2,397) from five Canadian postsecondary institutions were assigned to the intervention or the control group and were administered a survey at baseline, postintervention, and at 2-month follow-up (September 2017 to February 2018). We applied generalized linear mixed effects (PROC Mixed procedure) to test the between-group difference in the post-pre/follow-up-pre and to determine the predicted least-square mean values.

RESULTS

The findings showed that students who were exposed to the Transitions intervention significantly improved their mental health knowledge, decreased stigma against mental illness, improved help-seeking attitudes and behaviours, and decreased perceived stress when compared to students who had not been exposed to the intervention. However, we did not identify significant changes in general health. This may be due to the relatively short follow-up time (2 months) to determine participants' general health status.

CONCLUSIONS

Transitions delivered to first-year postsecondary students may be a beneficial intervention to help young people adjust to their new postsecondary life and improve their mental health.

The program evaluation of 'Go-To Educator Training' on educators' knowledge about and stigma toward mental illness in six Canadian provinces

AIM

Schools are well positioned to promote mental health literacy and assist in the early identification of students who may have a mental disorder. However, many educators are unprepared to effectively address these issues. Enhancing this capacity may improve mental health outcomes for students. This report describes the application of a gatekeeper-type program, the 'Go-To Educator Training' (GTET), targeting educators whom students naturally gravitate toward for support, designed to improve educators' mental health knowledge and early identification skills and decrease stigma.

METHODS

GTET was conducted in six Canadian provinces (Ontario, Nova Scotia, New Brunswick, Newfoundland, Alberta and Manitoba) (2012-2015), with 949 secondary school educators involved. Pre- and postintervention mental health knowledge and stigma surveys were completed. Paired t-tests assessed change in knowledge and stigma. ANCOVA compared knowledge and stigma change across subgroups. Correlation measured the relationship between knowledge and stigma.

RESULTS

Knowledge significantly improved (t[919] = 58.40, P < .001, d = 2.12) and stigma significantly decreased (t[872] = 4.52, P < .001, d = 0.14). Similar results were identified within each province/region. Knowledge and stigma were correlated before (N = 922, r = .18, P < .01) and after the training (N = 888, r = .22, P < .01).

CONCLUSIONS

These results suggest GTET may be an effective school-based mental health related intervention. Further study is needed to measure its long-term impact and its role in addressing youth mental health care referrals.

Dos and Don'ts in Designing School-Based Awareness Programs for Suicide Prevention

Abstract.Background: Despite the promising evidence for the effectiveness of school-based awareness programs in decreasing the rates of suicidal thoughts and suicide attempts in young people, no guidelines on the targets and methods of safe and effective awareness programs exist. Aims: This study intends to distill recommendations for school-based suicide awareness and prevention programs from experts. Method: A three-stage Delphi survey was administered to an expert panel between November 2018 and March 2019. A total of 214 items obtained from open-ended questions and the literature were rated in two rounds. Consensus and stability were used as assessment criteria. Results: The panel consisted of 19 participants in the first and 13 in the third stage. Recommended targets included the reduction of suicide attempts, the enhancement of help-seeking and peer support, as well as the promotion of mental health literacy and life skills. Program evaluation, facilitating access to healthcare, and long-term action plans across multiple levels were among the best strategies for the prevention of adverse effects. Limitations: The study is based on opinions of a rather small number of experts. Conclusion: The promotion of help-seeking and peer support as well as facilitating access to mental health-care utilities appear pivotal for the success of school-based awareness programs.

Establishment and validation of a mental health literacy measurement in Canadian educators

We aim to create the first mental health literacy measure addressing mental health knowledge of educators and assess its psychometric properties. We developed a 30-item multiple choice measure, Mental Health Literacy Tool for Educators (MHL-ED), with experts in both mental health and education. We administered it to educators (n = 909) from 6 Canadian provinces. We analysed the factor structure, internal consistency reliability, construct validity and responsiveness to change of MHL-ED. Factor analysis resulted in 4 factors of MHL-ED addressing: general mental illness and related treatment; assessment and diagnostic tools and treatments; causes and risk factors of mental illness; and epidemiology of mental health and mental illness. MHL-ED demonstrated strong internal consistency reliability. The construct validity was established because the hypothesis was supported that school based mental health professionals scored significantly higher than classroom teachers and school administrators/school support staff; and further MHL-ED scores were positively related with stigma measures. We did not identify floor or ceiling effects of MHL-ED. MHL-ED is reliable and valid to evaluate mental health literacy levels among educators working in junior high and secondary school settings, and may be considered for use in future research in this field.

The quality of mental health literacy measurement tools evaluating the stigma of mental illness: a systematic review

AIMS

Stigma of mental illness is a significant barrier to receiving mental health care. However, measurement tools evaluating stigma of mental illness have not been systematically assessed for their quality. We conducted a systematic review to critically appraise the methodological quality of studies assessing psychometrics of stigma measurement tools and determined the level of evidence of overall quality of psychometric properties of included tools.

METHODS

We searched PubMed, PsycINFO, EMBASE, CINAHL, the Cochrane Library and ERIC databases for eligible studies. We conducted risk-of-bias analysis with the Consensus-based Standards for the Selection of Health Measurement Instruments checklist, rating studies as excellent, good, fair or poor. We further rated the level of evidence of the overall quality of psychometric properties, combining the study quality and quality of each psychometric property, as: strong, moderate, limited, conflicting or unknown.

RESULTS

We identified 117 studies evaluating psychometric properties of 101 tools. The quality of specific studies varied, with ratings of: excellent (n = 5); good (mostly on internal consistency (n = 67)); fair (mostly on structural validity, n = 89 and construct validity, n = 85); and poor (mostly on internal consistency, n = 36). The overall quality of psychometric properties also varied from: strong (mostly content validity, n = 3), moderate (mostly internal consistency, n = 55), limited (mostly structural validity, n = 55 and construct validity, n = 46), conflicting (mostly test-retest reliability, n = 9) and unknown (mostly internal consistency, n = 36).

CONCLUSIONS

We identified 12 tools demonstrating limited evidence or above for (+, ++, +++) all their properties, 69 tools reaching these levels of evidence for some of their properties, and 20 tools that did not meet the minimum level of evidence for all of their properties. We note that further research on stigma tool development is needed to ensure appropriate application.

School- and Community-Based Youth Suicide Prevention Interventions: Hot Idea, Hot Air, or Sham?

Suicide in young people is a significant health concern, with numerous community- and school-based interventions promising to prevent suicide currently being applied across Canada. Before widespread application of any one of these, it is essential to determine its effectiveness and safety. We systematically reviewed the global literature on one of the most common community suicide prevention interventions in Canada and summarized data on 2 commonly applied school-based suicide prevention programmes. None of these has demonstrated effectiveness in preventing youth suicide or safety in application. Concurrently with their widespread distribution in Canada, the suicide rate in young women has increased-the first time in over 3 decades. Policy and regulatory implications of these findings are discussed.

Measurement properties of mental health literacy tools measuring help-seeking: a systematic review

BACKGROUND

Mental health literacy is important to improve help-seeking behaviors. However, the quality of mental health help-seeking tools remains unknown.

AIMS

We conducted a systematic review to appraise the quality of such tools.

METHODS

We searched databases for English publications addressing psychometrics of help-seeking tools. We included help-seeking tools addressing mental health in general and tools on four mental disorders: anxiety, depression, attention deficit hyperactivity disorder (ADHD) and schizophrenia. We determined the methodological quality of studies as "excellent", "good", "fair", or "indeterminate". We ranked the level of evidence of each measurement property as "strong", "moderate", "limited", "conflicting" or "unknown".

RESULTS

We found 12 help-seeking tools in 24 studies that assessed related psychometrics. The methodological quality of included studies ranged from "poor" to "excellent" with four studies on the content validity, structural validity or internal consistency demonstrating "excellent" quality. Three tools demonstrated overall strong evidence (content or structural validity); eight tools demonstrated moderate evidence (internal consistency, structural or construct validity); and eight tools demonstrated limited evidence (reliability, construct validity or internal consistency).

CONCLUSIONS

We recommend the application of tools with strong or moderate evidence for their psychometric properties. Future research may focus on the generalizability of the tools across diverse settings.

Facing the challenge of care for child and youth mental health in Canada: a critical commentary, five suggestions for change and a call to action

Neuropsychiatric disorders contribute most to the global burden of disease in young people (World Health Organization [WHO] 2003), approaching about 30% of the total global disease burden in those aged 10-19 years. Comparative data are not available for Canada, but the proportional burden of mental disorders in Canadian youth would be expected to be higher as our rates of human immunodeficiency virus/acquired immunodeficiency syndrome, tuberculosis, malaria and iron-deficiency disorders are substantially less than those in low-income countries. National estimates identify that about 15% of Canadian young people suffer from a mental disorder, but only about one in five of those who require professional mental health care actually receive it (Government of Canada 2006; Health Canada 2002; Kirby and Keon 2006; McEwan et al. 2007; Waddell and Shepherd 2002). And recent reports suggest that the human fallout from this reality may go beyond the well-known negative impacts of early-onset mental disorders on social, interpersonal, vocational and economic outcomes. For example, rates of mental disorder are very high in incarcerated youth, suggesting that, for some, jails are becoming the home for mentally ill young people (Kutcher and McDougall 2009).

Preparing for the Classroom: Mental Health Knowledge Improvement, Stigma Reduction and Enhanced Help-Seeking Efficacy in Canadian Preservice Teachers

Mental health literacy is fundamental to improving knowledge about mental health, decreasing stigma, and, therefore, enhancing help-seeking behaviors. The purpose of this cohort study is to evaluate the impact of a mental health literacy program on preservice teachers’ knowledge, attitudes, and help-seeking efficacy. Sixty preservice teachers in a Canadian university participated in a professional development day and completed a survey of their mental health knowledge, attitudes toward mental illness, and help-seeking efficacy. Compared with baseline data, results demonstrated significant and substantial improvements on all three outcomes immediately following the session and after 3 months. Provision of mental health literacy education among preservice teachers may be an effective approach to help them better address student mental health needs in their future teaching career.

Measurement properties of tools measuring mental health knowledge: a systematic review

BACKGROUND

Mental health literacy has received great attention recently to improve mental health knowledge, decrease stigma and enhance help-seeking behaviors. We conducted a systematic review to critically appraise the qualities of studies evaluating the measurement properties of mental health knowledge tools and the quality of included measurement properties.

METHODS

We searched PubMed, PsycINFO, EMBASE, CINAHL, the Cochrane Library, and ERIC for studies addressing psychometrics of mental health knowledge tools and published in English. We applied the COSMIN checklist to assess the methodological quality of each study as "excellent", "good", "fair", or "indeterminate". We ranked the level of evidence of the overall quality of each measurement property across studies as "strong", "moderate", "limited", "conflicting", or "unknown".

RESULTS

We identified 16 mental health knowledge tools in 17 studies, addressing reliability, validity, responsiveness or measurement errors. The methodological quality of included studies ranged from "poor" to "excellent" including 6 studies addressing the content validity, internal consistency or structural validity demonstrating "excellent" quality. We found strong evidence of the content validity or internal consistency of 6 tools; moderate evidence of the internal consistency, the content validity or the reliability of 8 tools; and limited evidence of the reliability, the structural validity, the criterion validity, or the construct validity of 12 tools.

CONCLUSIONS

Both the methodological qualities of included studies and the overall evidence of measurement properties are mixed. Based on the current evidence, we recommend that researchers consider using tools with measurement properties of strong or moderate evidence that also reached the threshold for positive ratings according to COSMIN checklist.

A school mental health literacy curriculum resource training approach: effects on Tanzanian teachers' mental health knowledge, stigma and help-seeking efficacy

BACKGROUND

Mental health literacy (MHL) is foundational for mental health promotion, prevention, stigma reduction, and care; School supported information pertaining to MHL in sub-Saharan Africa is extremely limited, including in Tanzania. Successful application of a school MHL curriculum resource may be an effective way to increase teacher MHL and therefore help to improve mental health outcomes for students.

METHODS

Secondary school teachers in Tanzania were trained on the African Guide (AG) a school MHL curriculum resource culturally adapted from a Canadian MHL resource (The Guide) for use in Africa. Teacher training workshops on the classroom application of the AG were used to evaluate its impact on mental health literacy in a sample of Tanzanian Secondary school teachers. Pre-post training assessment of participant knowledge and attitudes was conducted. Help-seeking efficacy for teachers themselves and their interventions for students, friends, family members and peers were determined.

RESULTS

Paired t test (n = 37) results demonstrate highly significant improvements in teacher's overall knowledge (p < 0.001; d = 1.14), including mental health knowledge, (p < 0.001; d = 1.14) and curriculum specific knowledge (p < 0.01; d = 0.63). Teachers' stigma against mental illness decreased significantly following the training (p < 0.001; d = 0.61). Independent t tests comparing the paired sample against unpaired sample also demonstrated significant differences between the groups for teacher's overall knowledge (p < 0.001). Teachers also reported high rates (greater than ¾ of the sample) of positive help-seeking efficacy for themselves as well as for their students, friends, family members and peers. As a result of the training, the number of students teachers identified for potential mental health care totaled over 200.

CONCLUSIONS

These positive results, when taken together with other research, suggest that the use of a classroom-based resource (the AG) that integrates MHL into existing school curriculum through training teachers may be an effective and sustainable way to increase the MHL (improved knowledge, decreased stigma and positive help-seeking efficacy) of teachers in Tanzania. As this study replicated the results of a previous intervention in Malawi, consideration could be given to scaling up this intervention in both countries and applying this resource and approach in other countries in East Africa.

Electronic interventions for depression in adolescents: hot idea or hot air?

Depressive disorders frequently onset in adolescence, and although effective treatments for these disorders are known, many youth have difficulty accessing care when needed. Electronic interventions and mobile applications have been posited as a possible solution for increasing access to affordable care. This narrative review explores the state of the evidence for their effectiveness, safety, and acceptability with teenagers. Although many electronic interventions and mobile applications have received widespread attention, minimal rigorous independent research has been conducted, and their use with teenagers who have depression cannot be recommended at this time.

A Pilot Study of Citalopram Treatment in Preventing Relapse of Depressive Episode after Acute Treatment

PURPOSE

To examine the benefit of continuation treatment with citalopram in adolescents 13 to 18 years of age with major depression using a multi-site randomized placebo controlled discontinuation design.

METHODS

Subjects with depression who responded to open label treatment with citalopram in 12-week acute phase were randomized to continued treatment with citalopram or placebo for 24 weeks.

RESULTS

Twenty five subjects were randomized to either continued treatment with citalopram (n = 12) versus placebo (n = 13). Seventy-five percent of subjects on citalopram (75%) remained well as compared to placebo (62%). Time to relapse was compared between groups using the log rank test and was not found to be significantly different (χ(2)(1) = 0.35, P = 0.55). A Cox proportional hazards model including drug assignment (hazard ratio (HR = 0.51, 95% CI 0.11 to 2.36, P = 0.39), gender (HR = 0.58, 95% CI 0.14 to 2.37, P = 0.44), or HAM-score at entry to continuation phase (HR = 1.33, 95% CI 0.90 to 1.95, P = 0.95) was not significant.

CONCLUSION

Although we did not find statistically significant differences between citalopram and placebo, the findings suggest a possible benefit of continued treatment with citalopram over placebo. A larger clinical trial with adequate power is required to confirm or disconfirm these findings.

Successful Application of a Canadian Mental Health Curriculum Resource by Usual Classroom Teachers in Significantly and Sustainably Improving Student Mental Health Literacy

OBJECTIVE

To investigate whether the significant and substantive findings from a previous study of youth mental health literacy (MHL) could be replicated using the same methods in another population.

METHOD

We examined the impact of a curriculum resource, the Mental Health and High School Curriculum Guide (The Guide), taught by usual classroom teachers on students' knowledge and attitudes related to mental health and mental illness in Canadian secondary schools. Survey data were collected before, immediately after, and 2 months after implementation of The Guide by teachers in usual classroom teaching. We conducted paired-sample t tests and calculated the Cohen d value to determine outcomes and impact of the curriculum resource application.

RESULTS

One hundred fourteen students were matched for analysis of knowledge data and 112 students were matched for analysis of attitude data at pre-intervention, post-intervention, and 2-month follow-up time periods. Following classroom exposure to the curriculum resource, students' knowledge scores increased significantly and substantively, compared with baseline (P < 0.001, d = 1.11), and this was maintained at 2-month follow-up (P < 0.001, d = 0.91). Similar findings for attitude improvement were found (P < 0.001, d = 0.66), and this improvement was maintained at 2-month follow-up (P < 0.001, d = 0.52).

CONCLUSIONS

These findings corroborate those from a previous study conducted in a different location. Taken together these results suggest a simple but effective approach to improving MHL in young people by embedding a classroom resource, delivered by usual classroom teachers in usual school settings.

Mental health literacy measures evaluating knowledge, attitudes and help-seeking: a scoping review

BACKGROUND

Mental health literacy has received increasing attention as a useful strategy to promote early identification of mental disorders, reduce stigma and enhance help-seeking behaviors. However, despite the abundance of research on mental health literacy interventions, there is the absence of evaluations of current available mental health literacy measures and related psychometrics. We conducted a scoping review to bridge the gap.

METHODS

We searched PubMed, PsycINFO, Embase, CINAHL, Cochrane Library, and ERIC for relevant studies. We only focused on quantitative studies and English publications, however, we didn't limit study participants, locations, or publication dates. We excluded non-English studies, and did not check the grey literature (non peer-reviewed publications or documents of any type) and therefore may have missed some eligible measures.

RESULTS

We located 401 studies that include 69 knowledge measures (14 validated), 111 stigma measures (65 validated), and 35 help-seeking related measures (10 validated). Knowledge measures mainly investigated the ability of illness identification, and factual knowledge of mental disorders such as terminology, etiology, diagnosis, prognosis, and consequences. Stigma measures include those focused on stigma against mental illness or the mentally ill; self-stigma ; experienced stigma; and stigma against mental health treatment and help-seeking. Help-seeking measures included those of help-seeking attitudes, intentions to seek help, and actual help-seeking behaviors.

CONCLUSIONS

Our review provides a compendium of available mental health literacy measures to facilitate applying existing measures or developing new measures. It also provides a solid database for future research on systematically assessing the quality of the included measures.

Mental health literacy in secondary schools: a Canadian approach

"Mental health literacy is an integral component of health literacy and has been gaining increasing attention as an important focus globally for mental health interventions. In Canada, youth mental health is increasingly recognized as a key national health concern and has received more focused attention than ever before within our health system. This article outlines 2 unique homegrown initiatives to address youth mental health literacy within Canadian secondary schools."

Hot Idea or Hot Air: A Systematic Review of Evidence for Two Widely Marketed Youth Suicide Prevention Programs and Recommendations for Implementation

INTRODUCTION

Youth suicide is highly related to mental disorders. While communities and schools are marketed to with a plethora of suicide prevention programs, they often lack the capacity to choose evidence-based programs.

METHODS

We conducted a systematic review of two youth suicide prevention programs to help determine if the quality of evidence available justifies their wide spread dissemination. We searched Medline, PsycINFO, EMBASE, CINAHL, the Cochrane Library, Campbell Collaboration SPECTR database, SocIndex, Sociological Abstracts, Social Services Abstracts, ERIC, Social Work Abstracts, Research Library, and Web of Science, for relevant studies. We included studies/systematic reviews/meta-analysis that evaluated the effectiveness, cost-effectiveness, and/or safety of Signs of Suicide (SOS) and Yellow Ribbon (YR) suicide prevention programs that target adolescents. We applied the Office of Justice Program What Works Repository (OJP-R) to evaluate the quality of the included studies as effective, effective with reservation, promising, inconclusive evidence, insufficient evidence, and ineffective. Two SOS studies were ranked as "inconclusive evidence" based on the OJP-R. One SOS study was ranked as having "insufficient evidence" on OJP-R. The YR study was ranked as "ineffective" using OJP-R. We only included studies in peer-reviewed journals in English and therefore may have missed reports in grey literature or non-English publications.

RESULTS

We cannot recommend that schools and communities implement either the SOS or YR suicide prevention programs. Purchasers of these programs should be aware that there is no evidence that their use prevents suicide.

CONCLUSIONS

Academics and organizations should not overstate the positive impacts of suicide prevention interventions when the evidence is lacking.

Sustained improvements in students' mental health literacy with use of a mental health curriculum in Canadian schools

BACKGROUND

Enhancement of mental health literacy for youth is a focus of increasing interest for mental health professionals and educators alike. Schools are an ideal site for addressing mental health literacy in young people. Currently, there is limited evidence regarding the impact of curriculum-based interventions within high school settings. We examined the effect of a high-school mental health curriculum (The Guide) in enhancing mental health literacy in Canadian schools.

METHODS

We conducted a secondary analysis on surveys of students who participated in a classroom mental health course taught by their usual teachers. Evaluation of students' mental health literacy (knowledge/attitudes) was completed before and after classroom implementation and at 2-month follow-up. We used paired-samples t-tests and Cohen's d value to determine the significance and impact of change.

RESULTS

There were 265 students who completed all surveys. Students' knowledge significantly improved between pre- and post-tests (p < 0.001; d = 0.90) and was maintained at follow-up (p < 0.001; d = 0.73). Similarly, attitude significantly improved between pre- and post-tests (p < 0.001; d = 0.25) and was significantly higher at follow-up than base-line (p < 0.007; d = 0.18) CONCLUSIONS: The Guide, applied by usual teachers in usual classroom curriculum, may help improve student knowledge and attitudes regarding mental health. This is the first study to demonstrate the positive impact of a curriculum-based mental health literacy program in a Canadian high school population.

Innovations in Practice: 'Go-to' Educator Training on the mental health competencies of educators in the secondary school setting: a program evaluation

BACKGROUND

Educators can play an important role in early identification and triage of youth with mental disorders. This paper reports findings of a program evaluation of the 'Go-To' Educator Training in a secondary school setting.

METHODS

Pre- and posttests were administered.

RESULTS

Participant mean scores on mental health competencies changed from 12 (40%) (standard deviation [SD] = 4.3) pretraining to 21 (70%) (SD = 3.3) posttraining, t(119) = 25.6, p < .0001, d = 2.3. Participant attitude mean scores improved from 49.9 (SD = 4.6) pretraining, to 51.5 (SD = 4.2), t(115) = 4.3, p < .0001, d = 0.36.

CONCLUSIONS

This training is a useful intervention to help educators identify youth with mental disorders and link them to appropriate services.

Pharmacy students' experiences in provision of community pharmacy mental health services

BACKGROUND

Little information is available describing the pharmacy student's experience working in community practice with people with lived experience of mental illness. Students' perspectives as observers, learners, technical staff and future pharmacists are important.

OBJECTIVE

To gain a better understanding of the pharmacy student experience in community pharmacy-based service provision to people with lived experience of mental illness.

METHODS

We conducted a qualitative study using interpretive description and application of the Theoretical Domains Framework. Focus groups were held with third- and fourth-year undergraduate pharmacy students from one Canadian university.

RESULTS

Two student focus groups were held in the fall of 2012 with 11 students (7 third year and 4 fourth year), 6 women and 5 men, mean age 24.5 (range, 21 to 30) years, averaging 3.2 years (range, 2 weeks to 7 years) of cumulative, mostly part-time, community pharmacy experience. Three broad themes emerged from the pharmacy student experience: (1) business tension; (2) roles, responsibilities and relationships; and (3) stigma. Students discussed their own roles, responsibilities and relationships in a pluralistic identity experience (i.e., pharmacy student, technician, future pharmacist). Application of the Theoretical Domains Framework demonstrated numerous influences on behaviour.

CONCLUSIONS

From the students' description of community pharmacy-based care of people with lived experience of mental illness, significant issues exist with current practices and behaviours. Advancing the role of pharmacists and pharmacy students to meet the needs of people with mental illness will require strategies to address multifactorial influences on behaviour.

Program evaluation of a child and youth mental health training program for family physicians in british columbia

INTRODUCTION

This brief report presents findings from the program evaluation of a portion of an educational program developed to support family physicians in improving their mental health care competencies in children and youth in British Columbia.

METHOD

The Child and Youth Mental Health (CYMH) learning module is part of a broader initiative from the Practice Support Program (PSP) of the British Columbia Medical Association and was created specifically to assist family physicians in improving their competencies in the identification, diagnosis and delivery of best evidence-based treatments for children and youth exhibiting the most common mental disorders that can be effectively treated in most primary care practices.

RESULTS

The initial results from the program evaluation demonstrate a substantial improvement in family physicians' knowledge of child and youth mental disorders and their self-rated clinical confidence in identifying and treating (both pharmacologically and psychotherapeutically) the most common child and youth mental disorders. Furthermore, because the training protocol involves a team-based approach which includes specialist physicians as well as school counsellors and human services providers, collaboration between primary practice and other providers is enhanced.

CONCLUSION

The initial results encourage broader roll-out and further evaluation of this program on a wider scale.

The effectiveness of school mental health literacy programs to address knowledge, attitudes and help seeking among youth

AIM

Conduct a systematic review for the effectiveness of school mental health literacy programs to enhance knowledge, reduce stigmatizing attitudes and improve help-seeking behaviours among youth (12-25 years of age).

METHODS

Reviewers independently searched PubMed, PsycINFO, Cochrane Library, CINAHL, ERIC, grey literature and reference lists of included studies. They reached a consensus on the included studies, and rated the risk of bias of each study. Studies that reported three outcomes: knowledge acquisition, stigmatizing attitudes and help-seeking behaviours; and were randomized controlled trials (RCTs), cluster RCTs, quasi-experimental studies, and controlled-before-and-after studies, were eligible.

RESULTS

This review resulted in 27 articles including 5 RCTs, 13 quasi-experimental studies, and 9 controlled-before-and-after studies. Whereas most included studies claimed school-based mental health literacy programs improve knowledge, attitudes and help-seeking behaviour, 17 studies met criteria for high risk of bias, 10 studies for moderate risk of bias, and no studies for low risk of bias. Common limitations included the lack of randomization, control for confounding factors, validated measures and report on attrition in most studies. The overall quality of the evidence for knowledge and help-seeking behaviour outcomes was very low, and low for the attitude outcome.

CONCLUSIONS

Research into school-based mental health literacy is still in its infancy and there is insufficient evidence to claim for positive impact of school mental health literacy programs on knowledge improvement, attitudinal change or help-seeking behaviour. Future research should focus on methods to appropriately determine the evidence of effectiveness on school-based mental health literacy programs, considering the values of both RCTs and other research designs in this approach. Educators should consider the strengths and weaknesses of current mental health literacy programs to inform decisions regarding possible implementation.

Challenges and Solutions in the Implementation of the School-Based Pathway to Care Model

Most mental disorders often onset during the adolescent years, providing opportunities for educators, health care providers, and related stakeholders to work collaboratively in addressing adolescent mental health care needs. This report describes early implementations of various components of the School-Based Pathway to Care Model currently applied in Canada, identifies lessons learned, and suggests future directions. The School-Based Pathway to Care Model engages students, teachers, student service providers, parents/families, health care providers, and the wider community through various training programs and both formal and informal linkages between the school, community, and health providers. Preliminary evaluation of the model in whole and in part shows promising outcomes for its application in secondary schools within the wider framework of enhancing system capacity for addressing mental health needs of students. Future focus should be directed towards more rigorous research on the model and its various components.

Evidence review and clinical guidance for the use of ziprasidone in Canada

While indicated for schizophrenia and acute mania, ziprasidone's evidence base and use in clinical practice extends beyond these regulatory approvals. We, an invited panel of experts led by a working group of 3, critically examined the evidence and our collective experience regarding the effectiveness, tolerability and safety of ziprasidone across its clinical uses. There was no opportunity for manufacturer input into the content of the review. As anticipated, ziprasidone was found to be effective for its indicated uses, although its utility in mania and mixed states lacked comparative data. Beyond these uses, the available data were either unimpressive or were lacking. An attractive characteristic is its neutral effect on weight thereby providing patients with a non-obesogenic long-term treatment option. Key challenges in practice include the need for dosing on a full stomach and managing its early onset adverse effect of restlessness. Addressing these issues are critical to its long-term success.

International school mental health: global approaches, global challenges, and global opportunities

School mental health programs from developed countries demonstrate that both the practice and research are becoming more important to policy makers, educators, health providers, parents, and other stakeholders. Some United Nations agencies and other international organizations have begun work to advance school mental health internationally. School-based mental health programming needs to be considered as part of usual child and youth mental health policies and plans, whether those are national or other jurisdictional in nature. Currently, a paucity of evidence-based and cost effective child and youth global mental health policies/programs exist, limiting school-based mental health programs being developed, implemented, or sustained.

Child and youth mental health: Integrated health care using contemporary competency-based teams

Mental health teams have long been the foundation for mental health services provided to children and youth. Changes in professional practices, the emergence of evidence-based care, the importance of integrating mental health into primary health care delivery, the decrease in professional 'ownership' of mental health care competencies and other factors now challenge the traditional structure and function of these teams. New and novel frameworks will be needed to address mental health care needs for problems that do not require 'traditional' mental health service interventions, to enable integration of mental health care into usual health services, to promote specialist mental health care delivery for those in need, and to facilitate the development and translation of mental health research into practice. In all of these new team structures, the active participation of young people and their families will be necessary.

Collaborating with youth to inform and develop tools for psychotropic decision making

INTRODUCTION

Youth oriented and informed resources designed to support psychopharmacotherapeutic decision-making are essentially unavailable. This article outlines the approach taken to design such resources, the product that resulted from the approach taken, and the lessons learned from the process.

METHODS

A project team with psychopharmacology expertise was assembled. The project team reviewed best practices regarding medication educational materials and related tools to support decisions. Collaboration with key stakeholders who were thought of as primary end-users and target groups occurred. A graphic designer and a plain language consultant were also retained.

RESULTS

Through an iterative and collaborative process over approximately 6 months, Med Ed and Med Ed Passport were developed. Literature and input from key stakeholders, in particular youth, was instrumental to the development of the tools and materials within Med Ed. A training program utilizing a train-the-trainer model was developed to facilitate the implementation of Med Ed in Ontario, which is currently ongoing.

CONCLUSION

An evidence-informed process that includes youth and key stakeholder engagement is required for developing tools to support in psychopharmacotherapeutic decision-making. The development process fostered an environment of reciprocity between the project team and key stakeholders.

Mental health care reforms in Latin America: child and adolescent mental health services in Mexico

This column provides an overview of child and adolescent mental health services in Mexico, where prevalence rates of mental disorders among young people are up to twice as high as U.S. and Canadian rates. The mental health care system in Mexico is underdeveloped and underfunded, and for the approximately 40% of the population with no insurance, access to and quality of care are particularly poor. This column offers policy recommendations aimed at better meeting the needs of this vulnerable population.