Objective: The coronavirus 2019 (COVID-19) pandemic is raising concerns about mental health across the population Because transgender and gender-diverse youth have particular mental health vulnerabilities, this study examines their mental health challenges during the early stages of the pandemic Method: A cross-sectional survey was conducted in the early COVID-19 pandemic period, which included 29 transgender and gender-diverse youth and 593 cisgender youth Descriptive statistics, Fisher's exact tests, and logistic regression analyses were conducted to understand the differential impact of COVID-19 on mental health and related constructs Results: Results show that transgender and gender diverse youth are more greatly affected by mental health challenges during the COVID-19 pandemic than cisgender youth (p = 001) They report more mental health and substance use service disruptions (p < 001) and less social support from their families (p = 007) compared with cisgender youth A large proportion (63 0%) report unmet needs for mental health and substance use during the early pandemic period, compared with 27 9% of cisgender youth (p = 008) Conclusions: Transgender and gender-diverse youth constitute a vulnerable population during the COVID-19 pandemic and are experiencing substantial mental health impacts, in conjunction with high levels of service disruption and less support from family members Researchers and service planners are encouraged to engage directly with transgender and gender diverse youth to understand how their support needs evolve over the course of the pandemic and how services can be adapted to meet their needs (PsycInfo Database Record (c) 2021 APA, all rights reserved) Impact Statement Because the COVID-19 pandemic is raising concerns about mental health, especially among vulnerable populations, we examined mental health during COVID-19 among youth with cisgender versus transgender and gender-diverse identities Results show that transgender and gender-diverse youth are experiencing substantial negative mental health impacts from the pandemic, more so than cisgender youth They also report more mental health and substance use service disruptions and less social support from their families compared with cisgender youth Researchers and service planners are encouraged to work directly with transgender and gender-diverse youth to understand how services can be adapted to meet their needs (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Mental health among transgender and gender diverse youth: An exploration of effects during the COVID-19 pandemic

Community-based, integrated youth service hubs have the potential to address some of the longstanding issues with mental health services for youth, including problems with access and system fragmentation. Better understanding of these approaches, particularly efforts to create a single point of entry to comprehensive, evidence-based services through youth service hubs, is needed to help guide future implementation and evaluation. This scoping review identifies the key principles and characteristics of these models of care, as well as the state of the literature, particularly with regard to implementation and replicability. Electronic databases and grey literature sources were searched for material from 2001 to 2019, with diverse search terms capturing the concept of “integrated” or “one-stop shop” youth mental health services. Title/abstract and full text review were conducted, as well as additional focused searching. After screening 4891 texts at the title/abstract level and 496 at the full-text level, 110 documents were included for data extraction. Several integrated care hub models for youth mental health services and related frameworks were identified internationally, largely in high-income countries. Common principles included an emphasis on rapid access to care and early intervention, youth and family engagement, youth-friendly settings and services, evidence-informed approaches, and partnerships and collaboration. Program characteristics also revealed similarities (e.g., providing evidence-informed or evidence-based services in youth-friendly spaces), with some differences (e.g., care coordination methods, types of service providers), potentially attributable to lack of available information about key ingredients. Outcome research was limited, with few rigorous evaluations of youth outcomes. Moreover, sufficient information for replication, community evaluation of feasibility or actual implementation was rarely provided. Internationally, integrated youth service hubs were found to share common key principles, while providing comprehensive services to youth with mental health difficulties. There is a great need for common language and measurement framework to facilitate replication, rigorous evaluation of outcomes, knowledge exchange, and dissemination of findings.

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Key attributes of integrated community-based youth service hubs for mental health: a scoping review

During the COVID-19 pandemic, youth mental health and substance use services rapidly moved to virtual modalities to meet social distancing requirements It is important to understand youth attitudes toward and experience of virtual services This study examined the attitudes toward and experiences of virtual mental health and substance use services among youth drawn from clinical and non-clinical samples Four hundred nine youth completed a survey including questions about their attitudes toward and experience of virtual services The survey included quantitative and open-ended questions on virtual care, as well as a mental health and substance use screener The majority of youth with mental health or substance use challenges would be willing to consider individual virtual services, but fewer would consider group virtual services However, many have not received virtual services Youth are interested in accessing a wide variety of virtual services and other supportive wellness services Advantages and disadvantages of virtual services are discussed, including accessibility benefits and technological barriers As youth mental health and substance use services have rapidly gone virtual during the COVID-19 pandemic, it is essential that we hear the perspectives of youth to promote service utilization among those in need Diverse, accessible, technologically stable virtual services are required to meet the needs of different youth, possibly with in-person options for some youth Future research, engaging youth in the research process, is needed to evaluate the efficacy of virtual services to plan for the sustainability of some virtual service gains beyond the pandemic period

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Going virtual: youth attitudes toward and experiences of virtual mental health and substance use services during the COVID-19 pandemic.

Objective This study analyses longitudinal data to understand how youth mental health and substance use are evolving over the course of the COVID-19 pandemic, which is critical to adjusting mental health response strategies. Setting Participants were recruited from among existing participants in studies conducted in an urban academic hospital in Ontario, Canada. Participants A total of 619 youth aged 14-28 years participated in the study (62.7% girls/young women; 61.4% Caucasian). Measures Data on mood, substance use and COVID-19-related worries were collected over four time points, that is, every 2 months beginning in the early stages of the pandemic in April 2020. Latent class analyses were conducted on the longitudinal data to identify distinct groups of youth who have different trajectory profiles of pandemic impact on their mood, substance use and COVID-19-related worries. Results For the majority of participants, mood concerns increased early in the pandemic, declined over Canada's summer months and subsequently increased in autumn. Among the youth with the highest level of mood symptoms at the beginning of the pandemic, increases in mental health concerns were sustained. Substance use remained relatively stable over the course of the pandemic. COVID-19-related worries, however, followed a trajectory similar to that of mood symptoms. Girls/young women, youth living in urban or suburban areas, in larger households, and with poorer baseline mental and physical health are the most vulnerable to mental health concerns and worries during the pandemic. Conclusions Youth mental health symptom levels and concerns are evolving over the course of the COVID-19 pandemic, in line with the evolution of the pandemic itself, and longitudinal monitoring is therefore required. It is also essential that we engage directly with youth to cocreate pandemic response strategies and mental health service adaptations to best meet the needs of young people.

https://bmjopen.bmj.com/content/bmjopen/11/10/e049209.full.pdf

Youth in a pandemic: a longitudinal examination of youth mental health and substance use concerns during COVID-19.

Objectives General practitioners (GPs) have a key role in supporting young people who present with suicidal behaviour/self-harm. However, little is known about young people’s opinions and experiences related to GPs’ practices for such presentations, and their decisions to disclose suicidal behaviour/self-harm to GPs. Additionally, existing guidelines for the management of suicide risk and/or self-harm have not incorporated young people’s perspectives. This study aimed to explore young people’s views and experiences related to the identification, assessment and care of suicidal behaviour and self-harm in primary care settings with GPs. Design, setting and participants Two qualitative focus groups were conducted in Perth, Western Australia, with 10 young people in total (Mage = 20.67 years; range: 16–24). Data were collected using a semistructured, open-ended interview schedule and analysed using thematic analysis. Results Five major themes were identified from the focus groups. (1) Young people wanted a collaborative dialogue with GPs, which included being asked about suicidal behaviour/self-harm, informed of treatment processes and having autonomy in decision making; (2) young people were concerned with a loss of privacy when disclosing suicidal behaviour/self-harm; (3) young people viewed labels and assessments as problematic and reductionist—disliking the terms ‘risk’ and ‘risk assessment’, and assessment approaches that are binary and non-holistic; (4) young people highlighted the importance of GPs’ attitudes, with a genuine connection, attentiveness and a non-judgemental demeanour seen as paramount; and (5) young people wanted to be provided with practical support and resources, followed-up, and for GPs to be competent when working with suicidal behaviour/self-harm presentations. Conclusions Our study identified several concerns and recommendations young people have regarding the identification, assessment and care of suicidal behaviour/self-harm in primary care settings. Taken together, these findings may inform the development of resources for GPs, and support progress in youth-oriented best practice.

https://bmjopen.bmj.com/content/bmjopen/10/10/e038855.full.pdf

Best practice when working with suicidal behaviour and self-harm in primary care: a qualitative exploration of young people’s perspectives

There are increasing calls to make mental health and substance use services youth friendly, with hopes of improving service uptake, engagement and satisfaction. However, youth-friendliness in this area has not been clearly defined and there is a lack of information about the characteristics that make such services youth friendly. The purpose of this scoping review was to examine the literature available on youth-friendly mental health and substance use services in order to identify the characteristics, outline the expected impacts, and establish a definition. A scoping review of seven databases and grey literature sources was conducted. Twenty-eight documents were retained as relevant to the research questions. Relevant data from these documents was extracted, analyzed and presented to stakeholders, including youth, caregivers and service providers to validate and refine the results. Youth-friendly mental health and substance use services include integrated, inclusive, confidential and safe organization and policy characteristics; bright, comfortable, environment with informational materials; welcoming and genuine service providers with appropriate communication and counselling skills; an accessible location; minimal wait times; and individualized and innovative approaches. All areas in which youth friendliness should be implemented in a mental health and substance use service organization had a core value of youth voice. Improving the youth friendliness of mental health and substance use services includes incorporating youth voice in organization, policy, environment, service providers, and treatment services, and has implications for treatment uptake, engagement and satisfaction. Further research is required to determine the impact of youth friendliness in such services.

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Jaqueline Relihan

Papers

What makes mental health and substance use services youth friendly? A scoping review of literature