scholarly journals A snapshot in time: a 1-month review of all referrals to paediatric liaison psychiatry services in Dublin following emergency department presentation

2021 ◽  
pp. 1-9
Author(s):  
Fiona McNicholas ◽  
Sorcha Parker ◽  
Elizabeth Barrett
Keyword(s):  
Young People ◽  
Length Of Stay ◽  
Mental Health Crisis ◽  
Liaison Psychiatry ◽  
Health Crisis ◽  
Out Of Hours ◽  
Alternative Pathways ◽  
Admission Rates ◽  
Self Harm ◽  
Profile Management

Introduction: An emerging picture has seen increasing numbers of young people with mental health crisis attend paediatric emergency departments in Ireland. Following paediatric review, many are referred to in-house paediatric liaison psychiatry (PLP) services. This pilot study describes referral patterns and practice over a 1-month period across three Dublin centres. Methods: Case notes of all referrals to PLP were reviewed to extract relevant clinical and administrative data. For those admitted, costs associated with length of stay were estimated. Clinical profile, management and intra-hospital pathway differences were explored. Results: Fifty-nine young people under 16 years presented to one of the three EDs with an acute MH presentation. The sample consisted of 39 females (66%) with a mean age of 13.7 years. The majority (n = 34, 58%) presented out of hours. A substantial portion of youths presenting (n = 37, 63%) were admitted, and had a mean duration of stay of 4.51 days. There were differences between hospitals in terms of frequency of presentation with self-harm, admission rates and length of stay. Discussion: Different PLP service configuration, staffing and funding streams may explain some of the differences observed across centres, although the findings should be interpreted with caution given the limited sample size. Standardisation of service provision and management is needed for PLP services. Additional community CAMHS resourcing is needed to support the development of alternative pathways for youth in need of urgent MH review.

scholarly journals Care-pathways for patients presenting to emergency ambulance services with self-harm: national survey

2020 ◽  
pp. emermed-2019-208967
Author(s):  
Mohammed Gaber Zayed ◽  
Victoria Williams ◽  
Alexander Charles Glendenning ◽  
Jenna Katherine Bulger ◽  
Tom Hewes ◽  
...  
Keyword(s):  
Mental Health ◽  
Hospital Admissions ◽  
Psychosocial Assessment ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Alternative Pathways ◽  
Mental Health Patients ◽  
Emergency Ambulance ◽  
Self Harm ◽  
The Uk

BackgroundSelf-harm is among the top five causes of acute hospital admissions and ambulance clinicians are often the first point of contact. However, the Emergency Department (ED) may not be the most appropriate place of care and little is known about the existence or nature of alternative pathways available to UK ambulance services. This survey describes the current management pathways used by ambulance services for patients who have self-harmed.MethodsA structured questionnaire was sent to all UK ambulance services by email and followed up by telephone in 2018. Three independent researchers (two clinical) coded responses which were analysed thematically.ResultsAll 13 UK ambulance services responded to the survey: nine by email and four by telephone interview. Two services reported a service-wide protocol for managing people presenting with self-harm, with referral to mental health crisis team available as an alternative to conveyance to ED, following on-scene psychosocial assessment. Four services reported local pathways for managing mental health patients which included care of patients who had self-harmed. Four services reported being in the process of developing pathways for managing mental health patients. Six services reported no service-wide nor local pathways for managing self-harm patients. No robust evaluation of new care models was reported.ConclusionPractice in ambulance services in the UK is variable, with a minority having a specific clinical pathway for managing self-harm, with an option to avoid ED. New pathways for patients who have self-harmed must be evaluated in terms of safety, clinical and cost-effectiveness.

scholarly journals Temporal trends in annual incidence rates for psychiatric disorders and self-harm among children and adolescents in the UK, 2003–2018

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lukasz Cybulski ◽  
Darren M. Ashcroft ◽  
Matthew J. Carr ◽  
Shruti Garg ◽  
Carolyn A. Chew-Graham ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Young People ◽  
Anxiety Disorders ◽  
Children And Adolescents ◽  
Autism Spectrum ◽  
Incidence Rates ◽  
Annual Incidence ◽  
Health Crisis ◽  
Self Harm ◽  
The Uk

Abstract Background There has been growing concern in the UK over recent years that a perceived mental health crisis is affecting children and adolescents, although published epidemiological evidence is limited. Methods Two population-based UK primary care cohorts were delineated in the Aurum and GOLD datasets of the Clinical Practice Research Datalink (CPRD). We included data from 9,133,246 individuals aged 1–20 who contributed 117,682,651 person-years of observation time. Sex- and age-stratified annual incidence rates were estimated for attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) (age groups: 1–5, 6–9, 10–12, 13–16, 17–19), depression, anxiety disorders (6–9, 10–12, 13–16, 17–19), eating disorders and self-harm (10–12, 13–16, 17–19) during 2003–2018. We fitted negative binomial regressions to estimate incidence rate ratios (IRRs) to examine change in incidence between the first (2003) and final year (2018) year of observation and to examine sex-specific incidence. Results The results indicated that the overall incidence has increased substantially in both boys and girls in between 2003 and 2018 for anxiety disorders (IRR 3.51 95% CI 3.18–3.89), depression (2.37; 2.03–2.77), ASD (2.36; 1.72–3.26), ADHD (2.3; 1.73–3.25), and self-harm (2.25; 1.82–2.79). The incidence for eating disorders also increased (IRR 1.3 95% CI 1.06–1.61), but less sharply. The incidence of anxiety disorders, depression, self-harm and eating disorders was in absolute terms higher in girls, whereas the opposite was true for the incidence of ADHD and ASD, which were higher among boys. The largest relative increases in incidence were observed for neurodevelopmental disorders, particularly among girls diagnosed with ADHD or ASD. However, in absolute terms, the incidence was much higher for depression and anxiety disorders. Conclusion The number of young people seeking help for psychological distress appears to have increased in recent years. Changes to diagnostic criteria, reduced stigma, and increased awareness may partly explain our results, but we cannot rule out true increases in incidence occurring in the population. Whatever the explanation, the marked rise in demand for healthcare services means that it may be more challenging for affected young people to promptly access the care and support that they need.

scholarly journals Young People’s Attitude Toward Positive Psychology Interventions: Thematic Analysis

10.2196/21145 ◽  
2020 ◽  
Vol 7 (4) ◽  
pp. e21145
Author(s):  
Toni Michel ◽  
Franziska Tachtler ◽  
Petr Slovak ◽  
Geraldine Fitzpatrick
Keyword(s):  
Mental Health ◽  
Young People ◽  
Positive Psychology ◽  
Thematic Analysis ◽  
Youth Mental Health ◽  
Personal Factors ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Positive Psychology Interventions ◽  
People’S Attitudes

Background Digital instantiations of positive psychology intervention (PPI) principles have been proposed to combat the current global youth mental health crisis; however, young people are largely not engaging with available resources. Objective The aim of this study is to explore young people’s attitudes toward various PPI principles to find ways of making digital instantiations of them more engaging. Methods We conducted an explorative workshop with 30 young people (aged 16-21 years). They rated and reviewed 29 common PPIs. Ratings and recorded discussions were analyzed using thematic analysis. Results Some interventions were conflicting with young people’s values or perceived as too difficult. Participants responded positively to interventions that fit them personally and allowed them to use their strengths. Conclusions Values, context, strengths, and other personal factors are entangled with young people’s attitudes toward digital instantiations of PPI principles.

scholarly journals Assessing young people who deliberately harm themselves

2000 ◽  
Vol 176 (2) ◽  
pp. 126-131 ◽  
Author(s):  
Jane Hurry ◽  
Pamela Storey
Keyword(s):  
At Risk ◽  
Young People ◽  
Service Management ◽  
Postal Questionnaire ◽  
Psychosocial Assessment ◽  
Old Patients ◽  
Admission Rates ◽  
Accident And Emergency ◽  
Patients At Risk ◽  
Self Harm

BackgroundMany young people who harm themselves have chronic mental health or social problems or are at risk of future self-harm or even suicide. The accident and emergency (A&E) clinic is an important gateway to treatment.AimsTo describe the psychosocial assessment of 12- to 24-year-old patients attending A&E clinics following deliberate self-harm (DSH) and to identify features of service management and provision which maximise specialist assessment.MethodA postal questionnaire was sent to a sample of one in three A&E departments in England. In a representative sample of 18 of these hospitals, staff were interviewed and 50 case notes per hospital were examined.ResultsPsychosocial assessment by non-specialist doctors in A&E departments tended to be of variable quality, focused on short-term risk. Around 43% of patients aged 12–24 were assessed by a specialist; specialist assessment was associated with high admission rates and the presence of on-site psychiatric departments and DSH teams.ConclusionsYoung DSH patients at risk often go unidentified; as a result their psychological problems may not be treated. Hospitals are frequently unaware of the proportion of patients discharged without adequate assessment.

scholarly journals Experiences and satisfaction of children, young people and their parents with alternative mental health models to inpatient settings: a systematic review

2019 ◽  
Vol 29 (12) ◽  
pp. 1621-1633
Author(s):  
Frane Vusio ◽  
Andrew Thompson ◽  
Max Birchwood ◽  
Latoya Clarke
Keyword(s):  
Mental Health ◽  
Young People ◽  
Help Seeking ◽  
Emotional Reactions ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Alternative Models ◽  
Searching Strategy ◽  
Crisis Services ◽  
Inpatient Settings

Abstract Community-based mental health services for children and young people (CYP) can offer alternatives to inpatient settings and treat CYP in less restrictive environments. However, there has been limited implementation of such alternative models, and their efficacy is still inconclusive. Notably, little is known of the experiences of CYP and their parents with these alternative models and their level of satisfaction with the care provided. Therefore, the main aim of this review was to understand those experiences of the accessibility of alternative models to inpatient care, as well as overall CYP/parental satisfaction. A searching strategy of peer-reviewed articles was conducted from January 1990 to December 2018, with updated searches conducted in June 2019. The initial search resulted in 495 articles, of which 19 were included in this review. A narrative synthesis grouped the studies according to emerging themes: alternative models, tele-psychiatry and interventions applied to crisis, and experiences and satisfaction with crisis provision. The identified articles highlighted increased satisfaction in CYP with alternative models in comparison with care as usual. However, the parental experiential data identified high levels of parental burden and a range of complex emotional reactions associated with engagement with crisis services. Furthermore, we identified a number of interventions, telepsychiatric and mobile solutions that may be effective when applied to urgent and emergency care for CYP experiencing a mental health crisis. Lastly, both parental and CYP experiences highlighted a number of perceived barriers associated with help-seeking from crisis services.

scholarly journals A Multicenter Study of Short-Term Changes in Mental Health Emergency Services Use During Lockdown in Kitchener-Waterloo, Ontario During the COVID-19 Pandemic

2021 ◽  
Author(s):  
Christopher Dainton ◽  
Simon Donato-Woodger ◽  
Charlene Chu
Keyword(s):  
Mental Health ◽  
Emergency Services ◽  
Suicide Attempts ◽  
Mental Health Crisis ◽  
Short Term ◽  
Health Crisis ◽  
Waterloo Region ◽  
Self Harm ◽  
Ed Visits ◽  
Services Use

Abstract Background The COVID-19 pandemic and subsequent lockdown measures have led to increasing mental health concerns in the general population. We aimed to assess the short-term impact of the pandemic lockdown on mental health emergency services use in the Kitchener-Waterloo region of Ontario, Canada. Methods We conducted an observational study during the 6-month period between March 5 and September 5, 2020 using National Ambulatory Care Reporting System metadata from mental health visits to three regional Emergency Departments (ED); mental health and substance related police calls; and calls to a regional mental health crisis telephone line, comparing volumes during the pandemic lockdown with the same period in 2019. Poisson regressions were used to determine significant differences between numbers of each visit or call type during the lockdown period versus the previous year. Results Involuntary admissions, substance related visits, mood related visits, situational crisis visits, and self-harm related mental health visits to the EDs were significantly reduced during the lockdown period compared to the year before. Psychosis-related and alcohol-related visits were not significantly reduced. Among police calls, suicide attempts were significantly decreased during the period of lockdown, but intoxication, assault, and domestic disputes were not significantly different. Mental health crisis telephone calls were significantly decreased during the lockdown period. Conclusions Contrary to our hypothesis, the decrease in most types of mental health ED visits, mental health and substance-related police calls, and mental health crisis calls largely mirrored the overall decline in emergency services usage during the lockdown period. This finding is unexpected in the context of increased attention to acutely deteriorating mental health during the COVID-19 pandemic.

scholarly journals Young People’s Attitude Toward Positive Psychology Interventions: Thematic Analysis (Preprint)

2020 ◽  
Author(s):  
Toni Michel ◽  
Franziska Tachtler ◽  
Petr Slovak ◽  
Geraldine Fitzpatrick
Keyword(s):  
Mental Health ◽  
Young People ◽  
Positive Psychology ◽  
Thematic Analysis ◽  
Youth Mental Health ◽  
Personal Factors ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
P Values ◽  
People’S Attitudes

BACKGROUND Digital instantiations of positive psychology intervention (PPI) principles have been proposed to combat the current global youth mental health crisis; however, young people are largely not engaging with available resources. OBJECTIVE The aim of this study is to explore young people’s attitudes toward various PPI principles to find ways of making digital instantiations of them more engaging. METHODS We conducted an explorative workshop with 30 young people (aged 16-21 years). They rated and reviewed 29 common PPIs. Ratings and recorded discussions were analyzed using thematic analysis. RESULTS Some interventions were conflicting with young people’s values or perceived as too difficult. Participants responded positively to interventions that fit them personally and allowed them to use their strengths. CONCLUSIONS Values, context, strengths, and other personal factors are entangled with young people’s attitudes toward digital instantiations of PPI principles.

How well do children in the North East of England function after a crisis: a service evaluation

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Emily Staite ◽  
Lynne Howey ◽  
Clare Anderson ◽  
Paula Maddison
Keyword(s):  
Mental Health ◽  
Young People ◽  
Health Services ◽  
Service Evaluation ◽  
Mental Health Crisis ◽  
Health Crisis ◽  
Content Type ◽  
North East ◽  
The North ◽  
The Uk

Purpose Data shows that there is an increasing number of young people in the UK needing access to mental health services, including crisis teams. This need has been exacerbated by the current global pandemic. There is mixed evidence for the effectiveness of crisis teams in improving adult functioning, and none, to the authors’ knowledge, that empirically examines the functioning of young people following intervention from child and adolescent mental health services (CAMHS) crisis teams in the UK. Therefore, the purpose of this paper is to use CAMHS Crisis Team data, from an NHS trust that supports 1.4 million people in the North East of England, to examine a young person's functioning following a crisis. Design/methodology/approach This service evaluation compared functioning, as measured by the Outcome Rating Scale (ORS), pre- and post-treatment for young people accessing the CAMHS Crisis Team between December 2018 and December 2019. Findings There were 109 participants included in the analysis. ORS scores were significantly higher at the end of treatment (t(108) = −4.2046, p < 0.001) with a small effect size (d = −0.36). Sixteen (15%) patients exhibited significant and reliable change (i.e. functioning improved). A further four (4%) patients exhibited no change (i.e. functioning did not deteriorate despite being in crisis). No patients significantly deteriorated in functioning after accessing the crisis service. Practical implications Despite a possibly overly conservative analysis, 15% of patients not only significantly improved functioning but were able to return to a “healthy” level of functioning after a mental health crisis following intervention from a CAMHS Crisis Team. Intervention(s) from a CAMHS Crisis Team are also stabilising as some young people’s functioning did not deteriorate following a mental health crisis. However, improvements also need to be made to increase the number of patients whose functioning did not significantly improve following intervention from a CAMHS Crisis Team. Originality/value This paper evaluates a young person’s functioning following a mental health crisis and intervention from a CAMHS Crisis Team in the North East of England.

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