The aim of this paper was to review the literature on adolescent psychiatric disorders related to the COVID-19 pandemic and lockdown Stressful life events, extended home confinement, brutal grief, intrafamilial violence, overuse of the Internet and social media are factors that could influence the mental health of adolescents during this period The COVID-19 pandemic could result in increased psychiatric disorders such as Post-Traumatic Stress, Depressive, and Anxiety Disorders, as well as grief-related symptoms Adolescents with psychiatric disorders are at risk of a break or change in their care and management; they may experience increased symptoms The COVID-19 pandemic and lockdown may have a negative impact on the mental health of adolescents, although there is still no data on the long term impact of this crisis Adolescents' individual, familial, and social vulnerability, as well as individual and familial coping abilities, are factors related to adolescent mental health in times of crisis Adolescents are often vulnerable and require careful consideration by caregivers and healthcare system adaptations to allow for mental health support despite the lockdown Research on adolescent psychiatric disorders in times of pandemics is necessary, as such a global situation could be prolonged or repeated

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Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown.

Pediatric primary care is a key setting that all young children are expected to visit routinely in their early development. As such, a young child’s visits to her or his pediatrician present major opportunities to detect any developmental challenges the child is experiencing and take appropriate steps to intervene. The integration of behavioral health services into primary care can greatly increase the likelihood that at-risk children are identified and treated as early as possible, particularly in early childhood when primary care is the central universal access point and because primary care is a non-stigmatizing environment (American Academy of Child and Adolescent Psychiatry, 2009; Substance Abuse and Mental Health Services Administration, 2013).

Behavioral Health Integration in Primary Care

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

https://onlinelibrary.wiley.com/doi/pdf/10.1002/wps.20745

Transdiagnostic clinical staging in youth mental health: a first international consensus statement

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.

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

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.

/pdf/integrated-one-stop-shop-youth-health-care-best-available-4lus4z0wdr.pdf

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

Aim There has been a global movement towards transformation of youth mental health services, but limited information on the core principles and characteristics of these new services is available. Jigsaw is one such service, established in Ireland in 2006, with the intent of creating change in Ireland's system of mental healthcare for 12-25 year olds. The aim of this paper is to describe the evolution of Jigsaw services, which are now firmly embedded in the Irish system of care for young people, and recognized internationally as an established service network. Methods This paper describes provides an up-to-date description of the Jigsaw service model, key areas of evolution that have shaped this model, and identifies future directions in service development. Results Key attributes of the Jigsaw service model including therapeutic service, scope of practice, youth mental health promotion, youth participation, and monitoring/evaluation are described in this paper. Information on key enablers (funding and governance/quality) and service providers is also included. Conclusions Information on the core principles and characteristics of youth mental health services is important. This paper addresses a gap in the literature by describing the Jigsaw service model, which continues to evolve so that it is responsive to the needs of young people.

Joseph Duffy

Papers

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

Evolution of Jigsaw - a National Youth Mental Health Service.