scholarly journals Cohort profile: demographic and clinical characteristics of the MILESTONE longitudinal cohort of young people approaching the upper age limit of their child mental health care service in Europe

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e053373
Author(s):  
Suzanne E Gerritsen ◽  
Athanasios Maras ◽  
Larissa S van Bodegom ◽  
Mathilde M Overbeek ◽  
Frank C Verhulst ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Clinical Characteristics ◽  
Service Use ◽  
Care Service ◽  
Health Care Service ◽  
Young Person ◽  
Age Limit

PurposeThe presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports.ParticipantsSeven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at.Findings to dateThis cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self-reported problems and 18.6% were rated to be ‘markedly ill’, ‘severely ill’ or ‘among the most extremely ill’ by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year.Future plansAnalysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared.Trial registration numberNCT03013595.

scholarly journals Transition from child and adolescent mental health services to adult mental health services

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S347-S348
Author(s):  
Tania Saour
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Clinical Information ◽  
Young Person ◽  
Timely Manner ◽  
Team Meetings ◽  
Significant Barrier ◽  
Transition Plan

BackgroundThe prevalence and recognition of mental health conditions in young people is growing. Around 50% of lifetime mental illness (except dementia) begins by the age of 14. Around 75% of adults requiring secondary mental health services developed problems prior to 18.The TRACK study of young people's transitions from CAMHS to AMHS has found that up to a third of teenagers are lost from care during transition and a further third experience an interruption in their care.A CQUIN for Transition has concluded that young children should have a transition plan 6 months before they turn 18.MethodAll young people aged 17 and a half years old were included in the data collection for this audit. Clinical information was reviewed using the West London RIO computer system. While reviewing the clinical documentation I was recording whether:Transitional plans had been discussed with the young person.If yes, what were they?Had a referral been made to the appropriate service?ResultThere were 180 open cases to the Hounslow Adolescent Team. 35 cases were over 18:At least 16 of these cases needed to be closed as no intervention was being provided.14 cases had an unclear plan.Of the 25 cases aged between 17.5 and 18 years of age transitional plans were:Transition was discussed in 11 cases (44%). This meant that transitional plans were not discussed in 56% of young people.Of these 11 cases 7 referrals were completed. (28%)ConclusionThe lack of consistent protocols for transition remains a significant barrier to health care provided to young people.Transitional planning needs to take place in an effective and timely manner to ensure continued patient centred care.Transitional discussions to be made a regular agenda item at team meetings.Care co-ordinator to be informed and reminded that transitional plans need to be explored with young people.Following a re-audit of this data 6 months on 100% of cases over the age of 18 were closed and transition was discussed in the remaining 56%.

A systematic review of current approaches to managing demand and waitlists for mental health services

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Kerry A. Thomas ◽  
Annelise M. Schroder ◽  
Debra J. Rickwood
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Service Delivery ◽  
Care Service ◽  
Health Care Service ◽  
Clinical Effectiveness ◽  
Research Literature ◽  
Inclusion Criteria ◽  
Content Type

Purpose Timely access to effective treatment is a primary goal for mental health services; however, when demand exceeds available resources, services may place clients on a waitlist or restrict services. This paper aims to identify approaches used by mental health services to manage service demand and waitlists. Design/methodology/approach A review of research literature between 2009 and 2019 was conducted using the Medline, PsycINFO, CINAHL, Embase and Cochrane databases. Articles were screened and assessed against inclusion criteria and the methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool. Findings In total, 20 articles were located that met the inclusion criteria. Five demand management approaches were identified, namely, walk-in models, triage processes, multi-disciplinary care, patient-led approaches and service delivery changes. Research limitations/implications This review identifies effective approaches that services can consider adapting to their local setting; however, further research is needed to demonstrate the clinical effectiveness of services provided under these models. Originality/value This review makes a valuable contribution to mental health care service delivery by detailing the strategies that services have adopted to manage demand and, where available, comparative outcomes with traditional service delivery models.

scholarly journals Transitions in mental health care: The European Psychiatric Association contribution to reform in Bulgaria

2020 ◽  
Vol 63 (1) ◽  
Author(s):  
Julian Beezhold ◽  
Drozdstoy Stoyanov ◽  
Vladimir Nakov ◽  
Helen Killaspy ◽  
Wolfgang Gaebel ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Care ◽  
Care Service ◽  
Health Care Service ◽  
The European Union ◽  
Multiple Stakeholders ◽  
High Level

Abstract Background: The Bulgarian Ministry of Health invited the European Psychiatric Association (EPA) to evaluate Bulgarian mental health care service provision in 2018. Bulgarian mental health services face very significant challenges including a legacy of historic underfunding, internal conflicts, poor planning, and the emigration of very high numbers of younger skilled staff that had followed accession to the European Union. There were significant disputes between stakeholders regarding the way forward and had been at least two unsuccessful previous external agency interventions that had attempted to find solutions. Method: This EPA position paper describes in detail the EPA mission to Bulgaria including methodology, findings, recommendations, and finally the positive actions and changes that are now underway as a result of the EPA report and intervention aimed at contributing towards improving Bulgarian mental health services. Results: After meetings with multiple stakeholders in the Bulgarian mental health system and analysis of data on service delivery, workforce, funding and configuration the EPA Panel agreed a list of twenty recommendations for change. Conclusions: The EPA mission, with the collaboration of multiple stakeholders in Bulgaria, was successful in stimulating high level government action to improve mental health services. Despite longstanding differences, it was possible to involve the stakeholders in constructive dialogue. The importance of “speaking with one voice” was a key lesson learned.

scholarly journals Who is in the transition gap? Transition from CAMHS to AMHS in the Republic of Ireland

2015 ◽  
Vol 32 (1) ◽  
pp. 61-69 ◽  
Author(s):  
F. McNicholas ◽  
M. Adamson ◽  
N. McNamara ◽  
B. Gavin ◽  
M. Paul ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Service ◽  
Health Services ◽  
Young Person ◽  
Republic Of Ireland ◽  
Transition Boundary ◽  
The Republic ◽  
Service Need

ObjectiveThe ITRACK study explored the process and predictors of transition between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) in the Republic of Ireland.MethodFollowing ethical approval, clinicians in each of Ireland’s four Health Service Executive (HSE) areas were contacted, informed about the study and were invited to participate. Clinicians identified all cases who had reached the transition boundary (i.e. upper age limit for that CAMHS team) between January and December 2010. Data were collected on clinical and socio-demographic details and factors that informed the decision to refer or not refer to the AMHS, and case notes were scrutinised to ascertain the extent of information exchanged between services during transition.ResultsA total of 62 service users were identified as having crossed the transition boundary from nine CAMHS [HSE Dublin Mid-Leinster (n=40, 66%), HSE South (n=18, 30%), HSE West (n=2, 3%), HSE Dublin North (n=1, 2%)]. The most common diagnoses were attention deficit hyperactivity disorder (ADHD; n=19, 32%), mood disorders (n=16, 27%), psychosis (n=6, 10%) and eating disorders (n=5, 8%). Forty-seven (76%) of those identified were perceived by the CAMHS clinician to have an ‘on-going mental health service need’, and of these 15 (32%) were referred, 11 (23%) young people refused and 21 (45%) were not referred, with the majority (12, 57%) continuing with the CAMHS for more than a year beyond the transition boundary. Young people with psychosis were more likely to be referred [χ2 (2, 46)=8.96, p=0.02], and those with ADHD were less likely to be referred [χ2 (2, 45)=8.89, p=0.01]. Being prescribed medication was not associated with referral [χ2 (2, 45)=4.515, p=0.11]. In referred cases (n=15), there was documented evidence of consent in two cases (13.3%), inferred in another four (26.7%) and documented preparation for transition in eight (53.3%). Excellent written communication (100%) was not supported by face-to-face planning meetings (n=2, 13.3%), joint appointments (n=1, 6.7%) or telephone conversations (n=1, 6.7%) between corresponding clinicians.ConclusionsDespite perceived on-going mental health (MH) service need, many young people are not being referred or are refusing referral to the AMHS, with those with ADHD being the most affected. CAMHS continue to offer on-going care past the transition boundary, which has resource implications. Further qualitative research is warranted to understand, in spite of perceived MH service need, the reason for non-referral by the CAMHS clinicians and refusal by the young person.

scholarly journals Association between single session service attendance and clinical characteristics in administrative data

2021 ◽  
pp. 135910452110026
Author(s):  
Julian Edbrooke-Childs ◽  
Daniel Hayes ◽  
Rebecca Lane ◽  
Shaun Liverpool ◽  
Jenna Jacob ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Administrative Data ◽  
Clinical Characteristics ◽  
Secondary Analysis ◽  
Low Frequency ◽  
Future Research ◽  
Single Session

A large proportion of young people accessing specialist mental health services do so for a single session. The aim of the present study was to examine the characteristics of young people attending specialist mental health services for a single session and to examine associations between single session attendance and clinical characteristics. Secondary analysis of administrative data on N = 23,300 young people (mean age = 12.73 years, 57% female, 64% White British) was conducted. The mean number of sessions attended was 4.33 and 46% (10,669) attended for a single session. Multilevel logistic regression analysis showed that younger children, Black young people (OR = 1.20, 95% CI = 1.01–1.43) or those whose ethnicity was not stated (OR = 1.25, 95% CI = 1.15–1.35), young people with peer relationship difficulties (OR = 1.11, 95% CI = 1.04–1.19) or low frequency problems (OR = 1.06, 95% CI = 0.99–1.14), and those with more complexity factors (OR = 1.07, 95% CI = 1.04–1.10) were more likely to attend services for a single session. The present study sets out research questions to prompt future research: (1) the experience of attending services for a single session, (2) identifying groups of single session attenders who do not require further support compared to those who are not able to sustain engagement with more sessions, and (3) whether new care pathways are needed for these groups who currently access specialist mental health services for a single session.

Demographic and clinical characteristics of young people seeking help at youth mental health services: baseline findings of the Transitions Study

2014 ◽  
Vol 9 (6) ◽  
pp. 487-497 ◽  
Author(s):  
Rosemary Purcell ◽  
Anthony F. Jorm ◽  
Ian B. Hickie ◽  
Alison R. Yung ◽  
Christos Pantelis ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Clinical Characteristics ◽  
Youth Mental Health ◽  
Seeking Help

Young offenders ' and their families ' experiences of mental health interventions

2015 ◽  
Vol 10 (4) ◽  
pp. 353-364 ◽  
Author(s):  
Anna Jack ◽  
Caroline Lanskey ◽  
Joel Harvey
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Young Person ◽  
Small Sample ◽  
Health Interventions ◽  
Content Type ◽  
Intervention Process ◽  
Mental Health Interventions

Purpose – The purpose of this paper is to explore the relevance of young people ' s experiences of mental health interventions with Child and Adolescent Mental Health Services (CAMHS) before and during their time with youth offending services. Design/methodology/approach – This qualitative interpretive study involved 14 interviews with young people who had offended, five of their carers and five CAMHS professionals from one local authority. Findings – The paper identifies understanding, recognition, respect and trust as key principles in the practitioner-young person relationship, and in the intervention process more broadly, and suggests that systematic consultation with young people and their caregivers about their experience of mental health interventions would be beneficial. It notes important similarities and differences in the views of the different parties which shed further light on reasons why a young person may or may not engage with mental health services. Research limitations/implications – The study is based on a small sample of young people from one service, but it is hoped that the findings will be a useful springboard for other services to reflect upon. Practical implications – The paper proposes the importance of recognising young people ' s agency in the intervention process and the value of systematic consultation with young people and their caregivers for securing their engagement in interventions. Originality/value – The study takes a multi-perspective approach (of young people, their carers and practitioners) to capture the synergies and tensions in the expectations of and interactions between young people, practitioners and caregivers.

A systematic review of service transitions in people with ADHD

2016 ◽  
Vol 33 (S1) ◽  
pp. S58-S58
Author(s):  
F. McNicholas ◽  
M. Tatlow-Golden ◽  
B. Gavin ◽  
S. Singh
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Grey Literature ◽  
Young Person ◽  
Service Development ◽  
Transition Boundary ◽  
Low Rate

BackgroundYoung people (YP) with attention deficit hyperactivity disorder (ADHD) are recognized to be a group who are particularly vulnerable to falling through the gap regarding transitioning from Child and Adolescent Mental health Services (CAMHS) to Adult Mental Health Services (AMHS). This presentation will combine a systematic review of the literature with some clinical examples of the pathway for a number of YP with ADHD who reach the transition boundary (TB).Method(1) Databases (e.g., PubMed, PsycINFO, AMED, CINAHL, EMBASE, Web of Knowledge), and grey literature, were searched systematically with database-specific key words, variants and truncations, to cover six subject areas: ADHD; transition or transfer; age; experiences or views; service development; and policies or protocols. Hand searching of key journals, ancestry and forward searches of references, and expert consultation were conducted. Two reviewers critically evaluated studies using a validated appraisal tool for mixed methodologies and findings were synthesized. (2) Following ethical approval, CAMHS clinicians from 9 clinics in Republic of Ireland identified all cases where a YP with ADHD had reached the TB, and identified referral/service outcomes (n = 20).ResultsThe search yielded 27 studies, covering areas of service review and recommendations (7), guidelines (3), medication (5), case note audit (3), professional's views (5), pilot transition clinics (2). A further set of papers covered the perspective of the young person (4) and parent (2). Overall these highlighted the less than optimum experience by both clinicians and service users of the experience with suggestions for future developments. These findings were mirrored in the review of clinical notes and individual interviews of YP identified through their CAMHS. Of the 20 young people identified, only 1 was directly transferred to AMHS. Eight were retained in CAMHS, on average for over a year. A significant number (7) refused onward referral. A perception from CAMHS clinicians, that AMHS did not accept such cases or lacked relevant service/expertise, may have contributed to the low rate of referral.ConclusionBoth the extant literature and the specific study presented highlight the lack of clear cut consensus about the appropriate management of young people with ADHD have who reach the transition boundary. Low rates of AMHS transfer may come from CAMHS clinicians’ perceptions of AMHS, and preferences of young people and families. Before assuming the very low rate of referral by CAMHS clinicians is poor practice, clinical outcomes need to be identified, young people's reasons for refusing transfer explored and service options identified.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Higher Rates of Untreated Distress in Older Versus Younger Adults With Indolent Lymphoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 466-466
Author(s):  
Kelly Trevino ◽  
Peter Martin ◽  
John Leonard
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Service Use ◽  
Mental Health Service Use ◽  
Health Service Use ◽  
Younger Adults

Abstract Indolent lymphomas are incurable but slow-growing cancers, resulting in a large number of older adults living with these diseases. Patients typically live with their illness for years with the knowledge that disease progression is likely. Yet, little is known about psychological distress in this population. This study examined rates of and the relationship between distress and mental health service use in older and younger adults with indolent lymphomas. Adult patients diagnosed with an indolent lymphoma (e.g., follicular lymphoma, marginal zone lymphoma) within the past six months completed self-report surveys of distress (Hospital Anxiety and Depression Scale; HADS) and mental health service use since the cancer diagnosis (yes/no). Descriptive statistics, t-tests, and chi-square analyses were used to examine study questions. The sample (n=84) included 35 patients 65 years or older. Across the entire sample, 21.4% screened positive for distress on the HADS; 58.8% of these patients did not receive mental health services. Older adults reported lower distress levels than younger adults (17.1% v. 24.5%; p=.038). Among younger adults, 50% of distressed patients received mental health services; only 20% of distressed older adults received mental health services. Distress was associated with mental health service use in younger adults (p=.004) but not in older adults (p=.17). Older adults with indolent lymphomas have higher levels of untreated distress than younger adults. Research on the mechanisms underlying these age differences (e.g., stigma toward mental health services, ageism) would inform interventions to increase rates of mental health service use and reduce care disparities due to age.

scholarly journals The divide between child and adult mental health services: points for debate

2013 ◽  
Vol 202 (s54) ◽  
pp. s41-s44 ◽  
Author(s):  
Clare Lamb ◽  
Margaret Murphy
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Discussion Paper ◽  
Adult Mental Health ◽  
The Uk

SummaryThis discussion paper outlines our personal views for debate on some of the complexities inherent in the crucial task of improving mental health services for young people in the UK.

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