Evaluating Model Fit

Although mental health problems represent the largest burden of disease in young people, access to mental health care has been poor for this group. Integrated youth health care services have been proposed as an innovative solution. Integrated care joins up physical health, mental health and social care services, ideally in one location, so that a young person receives holistic care in a coordinated way. It can be implemented in a range of ways. A review of the available literature identified a range of studies reporting the results of evaluation research into integrated care services. The best available data indicate that many young people who may not otherwise have sought help are accessing these mental health services, and there are promising outcomes for most in terms of symptomatic and functional recovery. Where evaluated, young people report having benefited from and being highly satisfied with these services. Some young people, such as those with more severe presenting symptoms and those who received fewer treatment sessions, have failed to benefit, indicating a need for further integration with more specialist care. Efforts are underway to articulate the standards and core features to which integrated care services should adhere, as well as to further evaluate outcomes. This will guide the ongoing development of best practice models of service delivery.

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Integrated (one-stop shop) youth health care: best available evidence and future directions.

Early intervention is a fundamental principle in health care and the past two decades have seen it belatedly introduced into the field of mental health. This began in psychotic disorders, arguably the least promising place to start. The steady accumulation of scientific evidence for early intervention has eventually overwhelmed the sceptics, transformed thinking in psychotic disorders and created an international wave of service reform. This paradigm shift has paved the way to a more substantial one: early intervention across the full diagnostic spectrum. 75% of mental illnesses emerge before the age of 25 years, and young people bear the major burden for those disorders that threaten the many decades of productive adult life. The paradox is that young people aged between 12 and 25 years have had by far the worst levels of access to mental health care across the whole lifespan. Health services are poorly designed, grossly under-resourced and typically unfriendly to, and untrusted by, young people. Furthermore, until recently there has been a quite striking lack of interest in this transitional age group from clinicians and researchers alike, who had unthinkingly accepted the paediatric-adult split of mainstream medicine without questioning its utility and validity for our field and our young patients. Over the past decade, however, a major shift in momentum has occurred to take early intervention in youth mental health more seriously. Here we discuss the recent advances and evidence supporting an innovative integrated model of youth mental health care and look to the future.

https://ebmh.bmj.com/content/ebmental/21/4/182.full.pdf

Early intervention in youth mental health: progress and future directions

The objective of this review is to report on recent developments in youth mental health incorporating all levels of severity of mental disorders encouraged by progress in the field of early intervention in psychotic disorders, research in deficiencies in the current system and social advocacy. The authors have briefly reviewed the relevant current state of knowledge, challenges and the service and research response across four countries (Australia, Ireland, the UK and Canada) currently active in the youth mental health field.
 Here we present information on response to principal challenges associated with improving youth mental services in each country. Australia has developed a model comprised of a distinct front-line youth mental health service (Headspace) to be implemented across the country and initially stimulated by success in early intervention in psychosis; in Ireland, Headstrong has been driven primarily through advocacy and philanthropy resulting in front-line services (Jigsaw) which are being implemented across different jurisdictions; in the UK, a limited regional response has addressed mostly problems with transition from child–adolescent to adult mental health services; and in Canada, a national multi-site research initiative involving transformation of youth mental health services has been launched with public and philanthropic funding, with the expectation that results of this study will inform implementation of a transformed model of service across the country including indigenous peoples. There is evidence that several countries are now engaged in transformation of youth mental health services and in evaluation of these initiatives.

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From early intervention in psychosis to youth mental health reform: a review of the evolution and transformation of mental health services for young people

Similar to other health care sectors, mental health has moved towards the secondary prevention, with the effort to detect and treat mental disorders as early as possible. However, converging evidence sheds new light on the potential of primary preventive and promotion strategies for mental health of young people. We aimed to reappraise such evidence. We reviewed the current state of knowledge on delivering promotion and preventive interventions addressing youth mental health. Half of all mental disorders start by 14 years and are usually preceded by non-specific psychosocial disturbances potentially evolving in any major mental disorder and accounting for 45% of the global burden of disease across the 0–25 age span. While some action has been taken to promote the implementation of services dedicated to young people, mental health needs during this critical period are still largely unmet. This urges redesigning preventive strategies in a youth-focused multidisciplinary and trans-diagnostic framework which might early modify possible psychopathological trajectories. Evidence suggests that it would be unrealistic to consider promotion and prevention in mental health responsibility of mental health professionals alone. Integrated and multidisciplinary services are needed to increase the range of possible interventions and limit the risk of poor long-term outcome, with also potential benefits in terms of healthcare system costs. However, mental health professionals have the scientific, ethical, and moral responsibility to indicate the direction to all social, political, and other health care bodies involved in the process of meeting mental health needs during youth years.

/pdf/prevention-and-early-intervention-in-youth-mental-health-is-3l0rqraafg.pdf

Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care?

AIM: The COVID-19 pandemic has presented significant challenges for young people and youth mental health services. To address a gap in knowledge about the impact of the pandemic and associated restrictions on youth mental health services, this paper examined the nature of young people's engagement with Jigsaw's brief intervention service during the pandemic. METHOD: Data gathered from young people engaging with Jigsaw's brief intervention service in the 12 months after the official declaration of the COVID-19 pandemic (n = 6161), and 12 months prior (n = 8665) were examined. RESULTS: There were less referrals to Jigsaw during the pandemic, especially during lockdown periods, but this rebounded when public health restrictions were eased. A higher proportion of females (p < .001) and 12-17 year olds (p < .001) were referred during the pandemic period. There was an increase in the proportion of young people who presented with anxiety (p < .001) and sleep changes (p < .001). Although 12-16 year olds reported significantly higher levels of distress during the pandemic (p < .05), the effect size was small. Young people reported high levels of satisfaction with the new phone/video modes of support offered by Jigsaw, and the overall attendance rate improved during the pandemic period. CONCLUSIONS: The impact of COVID-19 on young people's mental health needs to be considered as a priority. This paper is helpful for services considering the long-term mental health needs of young people, and the best way of meeting those needs.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/eip.13250

Gillian O'Brien

Papers

A year in perspective: The impact of the COVID-19 pandemic on engagement with Jigsaw youth mental health services.