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

Abstract

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.

Right care, first time: a highly personalised and measurement‐based care model to manage youth mental health

“…Further, greater functional impairment at entry tends to be associated with neurocognitive problems or difficulties, more severe mood or psychotic symptoms and concurrent substance (notably cannabis) misuse . Over time, while impairment may vary considerably for individuals, the overall pattern is largely one of stable trajectories, whereby the degree of impairment at entry to care is the main predictor of long term course …”

“…Some of the studies discussed below come from the University of Sydney's Brain and Mind Centre's Optymise Youth Cohort . This cohort includes 6743 individuals aged 12–30 years, 57% of whom are female.…”

“…These two dimensions are key tools for the assessment of clinical presentation within our larger multidimensional framework (Chapters 1 and 3) and are intended to be used as adjuncts to formal diagnosis. We describe these dimensions in detail in this chapter, and also present data from the University of Sydney's Brain and Mind Centre (BMC) Optymise Youth Cohort — a group of young people who were included in a longitudinal study tracking multidimensional outcomes for the duration of their engagement with youth mental health clinics at the BMC (Chapter 1) …”

“…However, current service delivery models are limited, resulting in young people frequently receiving no care or care that is not well matched to their individual needs . This can have adverse consequences including worsening of the syndrome, acute presentations to emergency departments, use of crisis services, hospitalisation, accumulation of greater physical and mental disorder comorbidities, and ongoing functional impairment …”

Moving beyond stepped care to staged care using a novel, technology‐enabled care model for youth mental health

“…However, despite the development of designated primary care‐style services (eg, headspace), we still do not deliver effective care, early in the course of illness, to most young people with anxiety, depression, or alcohol or other substance misuse . Even when we do deliver care, the longer term functional outcomes are often disappointing . The consequences of this failure remain large — personally, socially and economically …”