scholarly journals Delineating the trajectories of social and occupational functioning of young people attending early intervention mental health services in Australia: a longitudinal study

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020678 ◽  
Author(s):  
Frank Iorfino ◽  
Daniel F Hermens ◽  
Shane, PM Cross ◽  
Natalia Zmicerevska ◽  
Alissa Nichles ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Longitudinal Study ◽  
Early Intervention ◽  
Young People ◽  
Mental Disorders ◽  
Functional Impairment ◽  
Clinical Care ◽  
Occupational Functioning ◽  
Over Time

ObjectivesMental disorders typically emerge during adolescence and young adulthood and put young people at risk for prolonged socioeconomic difficulties. This study describes the longitudinal course of social and occupational functioning of young people attending primary care-based, early intervention services.DesignA longitudinal study of young people receiving mental healthcare.SettingData were collected between January 2005 and August 2017 from a designated primary care-based mental health service.Participants554 young people (54% women) aged 12–32 years.MeasuresA systematic medical file audit collected clinical and functional information at predetermined time intervals (ie, 3 months to 5+ years) using a clinical pro forma. Group-based trajectory modelling (GBTM) was used to identify distinct trajectories of social and occupational functioning over time (median number of observations per person=4; median follow-up time=23 months).ResultsBetween first clinical contact and time last seen, 15% of young people had reliably deteriorated, 23% improved and 62% did not demonstrate substantive change in function. Of the whole cohort, 69% had functional scores less than 70 at time last seen, indicative of ongoing and substantive impairment. GBTM identified six distinct functional trajectories whereby over 60% had moderate-to-serious functional impairment at entry and remained chronically impaired over time; 7% entered with serious impairment and deteriorated further; a quarter were mildly impaired at entry and functionally recovered and only a small minority (4%) presented with serious impairments and functionally improved over time. Not being in education, employment or training, previous hospitalisation and a younger age at baseline emerged as significant predictors of these functional trajectories.ConclusionYoung people with emerging mental disorders have significant functional impairment at presentation for care, and for the majority, it persists over the course of clinical care. In addition to providing clinical care earlier in the course of illness, these data suggest that more sophisticated and more intensive individual-level and organisational strategies may be required to achieve significant and sustained functional improvements.

scholarly journals Building Resilience in Adolescents and Youths - The Maltese Scene

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J M Cachia
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Young People ◽  
Mental Disorders ◽  
Peer Group ◽  
Group Development ◽  
Youth Mental Health ◽  
Well Being ◽  
Building Resilience ◽  
Health And Well Being

Abstract The Office of the Commissioner for Mental Health in Malta was established in 2011 to promote and protect rights of persons with mental disorders and their carers. This advocacy role includes monitoring of involuntary care, regular reporting on quality of care and care environments, in-depth analysis and recommendations on emerging issues such as mental health literacy, multidisciplinary care plans, drug addiction services and stigma and regular networking across ministries, agencies, departments, and NGOs, breaking silos and building bridges. Data for 2018 shows that acutely ill young people (10-29 year olds) were 30% of acute involuntary admissions. Males and foreign nationals from medium and least developed countries were more frequently represented. Substance abuse, mood disorders and psychotic disorders were the more common diagnostic groups. Building resilience and providing opportunities for early intervention are key elements of better mental health and well-being in the younger generation. Six examples of good practice in adolescent and youth mental health from Malta will be presented: Youth.inc by Aġenzija Żgħażagħ; Kellimni.com by SOS Malta; Youth Mental Health First Aid by Richmond Foundation; Research and Professional Education by ACAMH (Malta); Student Support Services at MCAST MALTA; Project Enlight! by Enlight Foundation. Two of these initiatives were recognised as best practices at European level in a peer learning exercise conducted by the Dutch Youth Institute. The recommendations are: more focused approaches towards young people with acute mental disorders with special attention to their specific needs; the identification of young people in trouble; work programmes that build resilience, life-skills and employment prospects; the intensified use of refined electronic and social media tools for promotion, prevention and early intervention; and active support and encouragement of peer group development and self-help initiatives. Key messages Networking stakeholders to break silos and build bridges. Resilience and early intervention for better mental health and well-being.

scholarly journals Detecting young people with mental disorders: a cluster-randomised trial of multidisciplinary health teams at the GP office

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e050036
Author(s):  
Ole Rikard Haavet ◽  
Jūratė Šaltytė Benth ◽  
Svein Gjelstad ◽  
Ketil Hanssen-Bauer ◽  
Mina Piiksi Dahli ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Young People ◽  
Mental Disorders ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Mental Health Disorders ◽  
Shared Care ◽  
Cluster Randomised ◽  
Health Disorders

BackgroundYoung people with mental health challenges present a major global challenge. More than half of adults with mental disorders experience their onset before age 14, but early detection and intervention may change this course. Shared care with mental health professionals in general practitioner (GP) offices has demonstrated its potential for improvement in these conditions.AimTo investigate whether shared care with mental health professionals in GP offices increases the detection of youth’s mental health disorders and is associated with a decrease in use of unspecified symptom diagnoses, as a whole and stratified by patient and physician gender and age, and type of consulting physician.Design and settingThis was a stratified cluster-randomised controlled trial with data extraction from electronic records. Two GP offices were recruited from each of three boroughs. Each borough had 3–8 GP offices. One GP office was randomised to the intervention group and the other to the control group.MethodWe used generalised linear mixed models to assess whether the intervention helped GPs identify more International Classification of Primary Care 2 diagnoses of depression, anxiety and unspecified symptoms in youth.ResultsOver a 18-month period between between 2015 and 2017, the intervention helped GPs identify more youth with anxiety (p=0.002 for interaction), but not depression. The increase was most significant among the patients’ regular GPs, less when patients met other GPs and least among external substitute physicians. The frequency of diagnoses with unspecified symptoms decreased in the intervention arm.ConclusionShared care with mental health professionals located in GP office contributed to increased detection of youth with anxiety symptoms. The increase was most prominent when the primary care physician was the patient’s regular GP. GPs need to pay greater attention to detecting anxiety in youth and embrace shared care models, thereby contributing to reduced mental health disorders in this age group.Trial registration numberNCT03624829; Results.

Suicidality and Treatment Experience Among Young People Who Inject Drugs

2020 ◽  
Author(s):  
Mary Ellen Mackesy-Amiti ◽  
Lawrence J. Ouellet
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Young People ◽  
Mental Disorders ◽  
Mental Health Treatment ◽  
People Who Inject Drugs ◽  
Multivariable Analysis ◽  
Psychiatric Research ◽  
Health Treatment ◽  
The Past

Background. We examined correlates of past year suicidal thoughts and behavior (STB) and described past year treatment experiences among young people who inject drugs (PWID). Methods. Participants were 570 adults (18-25 years) who injected primarily heroin. Interviews were conducted at field stations operated by Community Outreach Intervention Projects in Chicago, Illinois (USA). Interviewers administered the Psychiatric Research Instrument for Substance and Mental Disorders. Substance use and mental disorders were based on DSM-IV diagnostic criteria. Past year STB was based on multiple questions. Results. Sixteen percent of men and 25% of women reported STB in the past year. In multivariable analysis, STB was associated with non-heterosexual orientation, foster care, and being raised by two parents. Primary major depression, post-traumatic stress disorder, other anxiety disorders, and borderline personality disorder had independent effects on suicidality. Among those reporting past year STB (n=111), 83% ever received mental health treatment, while 44% did so in the past year. While 24% of respondents indicated that at least one treatment matched their needs very well, 30% reported treatment that did not match their needs at all. The most common reason for ending treatment was program completion (about 50%) while getting better was endorsed by about 25%. Nearly half reported ending treatment due to a bad experience, logistical issues, or expense. Conclusions. Young PWID are at high risk for suicidal behavior and their mental health treatment experiences often do not meet their needs. There is a pressing need for more integrated substance use and mental health treatment.

scholarly journals Impact of arthritis on the perceived need and use of mental healthcare among Canadians with mental disorders: nationally representative cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e041371
Author(s):  
Alyssa Howren ◽  
J Antonio Aviña-Zubieta ◽  
Deborah Da Costa ◽  
Joseph H Puyat ◽  
Hui Xie ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Clinical Care ◽  
Mental Healthcare ◽  
Cluster Sampling ◽  
Cross Sectional ◽  
Perceived Need ◽  
Mental Health Support ◽  
Health Support

ObjectiveTo evaluate the association between having arthritis and the perceived need for mental healthcare and use of mental health support among individuals with mental disorders.DesignA cross-sectional analysis using data from Canadian Community Health Survey—Mental Health (2012).SettingThe survey was administered across Canada’s 10 provinces using multistage cluster sampling.ParticipantsThe study sample consisted of individuals reporting depression, anxiety or bipolar disorder.Study variables and analysisThe explanatory variable was self-reported doctor-diagnosed arthritis, and outcomes were perceived need for mental healthcare and use of mental health support. We computed overall and gender-stratified multivariable binomial logistic regression models adjusted for age, gender, race/ethnicity, income and geographical region.ResultsAmong 1774 individuals with a mental disorder in the study sample, 436 (20.4%) reported having arthritis. Arthritis was associated with increased odds of having a perceived need for mental healthcare (adjusted OR (aOR) 1.71, 95% CI 1.06 to 2.77). In the gender-stratified models, this association was increased among men (aOR 2.69, 95% CI 1.32 to 5.49) but not women (aOR 1.48, 95% CI 0.78 to 2.82). Evaluation of the association between arthritis and use of mental health support resulted in an aOR of 1.50 (95% CI 0.89 to 2.51). Individuals with arthritis tended to use medications and professional services as opposed to non-professional support.ConclusionComorbid arthritis among individuals with a mental disorder was associated with an increased perceived need for mental healthcare, especially in men, underscoring the importance of understanding the role of masculinity in health seeking. Assessing the mental health of patients with arthritis continues to be essential for clinical care.

scholarly journals Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies

2021 ◽  
Author(s):  
Marco Solmi ◽  
Joaquim Radua ◽  
Miriam Olivola ◽  
Enrico Croce ◽  
Livia Soardo ◽  
...  
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Mental Disorders ◽  
Meta Analysis ◽  
Age At Onset ◽  
Autism Spectrum ◽  
Stress Disorders ◽  
Obsessive Compulsive ◽  
Good Mental Health ◽  
Significant Difference

AbstractPromotion of good mental health, prevention, and early intervention before/at the onset of mental disorders improve outcomes. However, the range and peak ages at onset for mental disorders are not fully established. To provide robust, global epidemiological estimates of age at onset for mental disorders, we conducted a PRISMA/MOOSE-compliant systematic review with meta-analysis of birth cohort/cross-sectional/cohort studies, representative of the general population, reporting age at onset for any ICD/DSM-mental disorders, identified in PubMed/Web of Science (up to 16/05/2020) (PROSPERO:CRD42019143015). Co-primary outcomes were the proportion of individuals with onset of mental disorders before age 14, 18, 25, and peak age at onset, for any mental disorder and across International Classification of Diseases 11 diagnostic blocks. Median age at onset of specific disorders was additionally investigated. Across 192 studies (n = 708,561) included, the proportion of individuals with onset of any mental disorders before the ages of 14, 18, 25 were 34.6%, 48.4%, 62.5%, and peak age was 14.5 years (k = 14, median = 18, interquartile range (IQR) = 11–34). For diagnostic blocks, the proportion of individuals with onset of disorder before the age of 14, 18, 25 and peak age were as follows: neurodevelopmental disorders: 61.5%, 83.2%, 95.8%, 5.5 years (k = 21, median=12, IQR = 7–16), anxiety/fear-related disorders: 38.1%, 51.8%, 73.3%, 5.5 years (k = 73, median = 17, IQR = 9–25), obsessive-compulsive/related disorders: 24.6%, 45.1%, 64.0%, 14.5 years (k = 20, median = 19, IQR = 14–29), feeding/eating disorders/problems: 15.8%, 48.1%, 82.4%, 15.5 years (k = 11, median = 18, IQR = 15–23), conditions specifically associated with stress disorders: 16.9%, 27.6%, 43.1%, 15.5 years (k = 16, median = 30, IQR = 17–48), substance use disorders/addictive behaviours: 2.9%, 15.2%, 48.8%, 19.5 years (k = 58, median = 25, IQR = 20–41), schizophrenia-spectrum disorders/primary psychotic states: 3%, 12.3%, 47.8%, 20.5 years (k = 36, median = 25, IQR = 20–34), personality disorders/related traits: 1.9%, 9.6%, 47.7%, 20.5 years (k = 6, median = 25, IQR = 20–33), and mood disorders: 2.5%, 11.5%, 34.5%, 20.5 years (k = 79, median = 31, IQR = 21–46). No significant difference emerged by sex, or definition of age of onset. Median age at onset for specific mental disorders mapped on a time continuum, from phobias/separation anxiety/autism spectrum disorder/attention deficit hyperactivity disorder/social anxiety (8-13 years) to anorexia nervosa/bulimia nervosa/obsessive-compulsive/binge eating/cannabis use disorders (17-22 years), followed by schizophrenia, personality, panic and alcohol use disorders (25-27 years), and finally post-traumatic/depressive/generalized anxiety/bipolar/acute and transient psychotic disorders (30-35 years), with overlap among groups and no significant clustering. These results inform the timing of good mental health promotion/preventive/early intervention, updating the current mental health system structured around a child/adult service schism at age 18.

scholarly journals Pathways to school belonging

2016 ◽  
Vol 33 (1) ◽  
pp. ii-iv
Author(s):  
Kelly Allen ◽  
Chris Boyle
Keyword(s):  
Mental Health ◽  
Social Issue ◽  
Early Intervention ◽  
Young People ◽  
Secondary School ◽  
Risk Taking ◽  
School Belonging ◽  
Special Issue ◽  
Health Concerns ◽  
Fitting In

School belonging is generally regarded as a student's sense of affiliation or connection to his or her school. Anyone who has personally navigated the sometimes torturous terrain of secondary school is able to have some level of direct understanding of the importance that belonging, fitting in, and identifying with a school holds for most people. Educators and practitioners often work with young people who feel that they do not belong to the school community, in which they attend. An absence of belonging can manifest itself in mental health concerns, school attrition, and risk taking behaviours. Opportunities for early intervention through fostering school belonging are born from a greater understanding and awareness of what school belonging is and how it is contextualised and fostered. This special issue aims to place a focus on school belonging and highlight it as a significant social issue of our time.

scholarly journals Is continuity of primary care declining in England? Practice-level longitudinal study, 2012-2017

2020 ◽  
pp. BJGP.2020.0935
Author(s):  
Peter Tammes ◽  
Richard Morris ◽  
Mairead Murphy ◽  
Chris Salisbury
Keyword(s):  
Primary Care ◽  
Longitudinal Study ◽  
Continuity Of Care ◽  
Multilevel Modelling ◽  
Population Characteristics ◽  
Urban Location ◽  
Practice Level ◽  
Level Data ◽  
Appointment System ◽  
Over Time

Background: Continuity of care is a core principle of primary care and related to improved patient outcomes and reduced healthcare costs. Evidence suggests continuity of care is declining. Aim: (i) to confirm reports of declining continuity of care, (ii) to explore differences in decline according to practice characteristics, (iii) to examine associations between practice populations or appointment provision and changes in continuity of care. Design and Setting: Longitudinal study of aggregated practice-level data from repeated questions in GP-Patient surveys between 2012-2017 on having a preferred GP, seeing this GP always/often (usually), appointment system and practice population characteristics, linked to rural/urban location and deprivation. Method: Multilevel modelling; time (level-1) and practices (level-2). Results: 56.7% of patients had a preferred GP in 2012, declining by 9.4%-points (95%CI -9.6 to -9.2) by 2017. 66.4% of patients with a preferred GP saw this GP usually in 2012, which declined by 9.7%-points (95%CI -10.0 to -9.4) by 2017. This decline was visible in all types of practices, irrespective of baseline continuity, rural/urban location, or deprivation. At practice-level, an increase over time in the percentage of patients reporting good overall experience of making appointments was associated with an increase in both the percentage of patients having a preferred GP, and the percentage of patients being able to see that GP usually. Conclusion: Patients reported a steady decline in continuity of care over time, which should concern clinicians and policymakers. The ability of practices to offer patients a satisfactorily working appointment system could partly counteract this decline.

scholarly journals Improving medical residents’ utilisation of integrated mental health in primary care

2021 ◽  
Vol 10 (3) ◽  
pp. e001388
Author(s):  
Jenna Palladino ◽  
Deirdra Frum-Vassallo ◽  
Joanne D Taylor ◽  
Victoria L Webb
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Medical Home ◽  
Medical Resident ◽  
Improvement Project ◽  
Mental Health Integration ◽  
Integrated Mental Health ◽  
Over Time

BackgroundIntegration of mental health services allows for improved prevention and management of chronic conditions within the primary care setting. This quality improvement project aimed to increase adherence to and functioning of an integrated care model within a patient-centred medical home. Specifically, the project focused on improving collaboration between Primary Care Mental Health Integration (PC-MHI) and the medical resident Patient Aligned Care Teams (PACT) at a Veterans Affairs Medical Center in Northport,New York (VAMC Northport).MethodThe project used increased education, training and relationship building among the medical resident PACTs, and the establishment of regularly occurring integrated team meetings for medical and mental health providers. Education of residents was measured with a self-assessment pre-training and post-training, while utilisation was measured by the percentage of patients currently on a PACT’s panel with at least one PC-MHI encounter in the last 12 months (known in VAMC Northport as PACT-15 metric).ResultsTwo resident PACTs that received both training and weekly integrated meetings increased their utilisation of integrated mental health services by 3.8% and 4.5%, respectively. PACTs that participated in training only, with no regular meetings, showed an initial improvement in utilisation that declined over time.ConclusionsTraining alone appeared beneficial but insufficient for increased integration over time. The addition of a regularly occurring integrated weekly meeting may be a critical component of facilitating sustained mental health integration in a primary care medical home model.

School and Community - based Youth Mental Health Intervention Studies in India: A Scoping Review

2019 ◽  
Vol 2 (02) ◽  
pp. 14-22
Author(s):  
Ragaviveka Gopalan ◽  
C Sangeetha ◽  
P Ramakrishnan ◽  
Vijaya Raghavan
Keyword(s):  
Mental Health ◽  
Young People ◽  
Mental Disorders ◽  
Youth Mental Health ◽  
Health Interventions ◽  
Community Based Interventions ◽  
Community Based ◽  
School Based ◽  
School And Community ◽  
Mental Health Interventions

BACKGROUND About 70% of mental disorders emerge in late childhood and young peo-ple bear the burden of these disorders throughout life. Yet, to date there has been com-paratively little research on mental health interventions for young people in India and not many attempts have been made to collate the existing literature. This systematic review aims to synthesize the available evidence on school- and community-based mental health interventions for young people in India. METHODS A range of major electronic databases were searched systematically, and the abstracts of relevant papers were independently examined for possible inclusion. Selected papers were read in full text and a standardized set of data items were extracted. RESULTS Four papers met inclusion criteria for the analysis; two studies of school-based interventions for adolescents and two studies evaluating out-of-school community interventions for youth were reviewed. The quality of evidence from the interventions in Indian school and community settings were poor. While two studies evidence the effectiveness of a school-based life skills programme and a community based multicomponent intervention designed to promote youth health, two other studies do not offer sufficient data. CONCLUSION The review findings indicate that the number of interventional studies conducted in India to address youth mental health issues are very limited. Hence, it is extremely difficult to ensure the feasibility and effectiveness of school and community-based interventions in India. Further research is warranted to establish whether interventions promoting youth mental health people can be implemented effectively in Indian settings with positive mental health outcomes. Given the possibility of a huge population of young people at-risk or experiencing mental disorders, evidence for the efficacy of youth mental health interventions is crucial.

scholarly journals A Novel Landscape for Understanding Physical and Mental Health: Body Mapping Research with Youth Experiencing Psychosis

2018 ◽  
Vol 3 (2) ◽  
pp. 236-261 ◽  
Author(s):  
Katherine M. Boydell ◽  
Jeffrey Ball ◽  
Jackie Curtis ◽  
Adèle De Jager ◽  
Megan Kalucy ◽  
...  
Keyword(s):  
Mental Health ◽  
Early Intervention ◽  
Young People ◽  
Physical Health ◽  
Social Issues ◽  
The Body ◽  
First Episode ◽  
Physical And Mental Health ◽  
Body Mapping ◽  
The Future

Estimates indicate the lifespan of individuals with psychotic illness is reduced by approximately 15-20 years. Consequently there is a need to address the physical health of those who live with a mental illness, like psychosis. The Bondi Centre provides an integrated model of care to young people with a first episode of psychosis. The Keeping the Body In Mind program focuses on prevention and early intervention of physical health issues and is offered alongside treatment for mental health and social issues as part of routine care. We used body mapping, an arts-based research method, to explore the complexity of this physical health intervention. Our aim was to develop an in-depth understanding of experiences of young clients of the early intervention centre, with a particular focus on the embodied relationship between physical and mental health. Six young people engaged in creating life-sized body maps depicting their experience of the physical intervention program over four 3-hour sessions, followed by an in-depth interview. Analysis of our body maps drew on thematic analysis and narrative inquiry. The narrative trope was one of recovery, highlighting the importance of the link between body and mind, individual and community, and the balance between light and darkness. There was an emphasis on developing feelings of connectedness (to self and others), hope and optimism for the future, a sense of having an identity, and a sense of meaning and empowerment. Recovery was conceptualised as an ongoing process rather than an end product or fixed state. Involvement in the body mapping process was consistently identified as therapeutic, offering an opportunity for reflection on the journey to recovery with a focus on past, present and imagined storylines of the future. 

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