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

Abstract

Abstract:Purpose: Developments in the field of early intervention in psychotic disorders have encouraged further examination of and interest in youth mental health incorporating all levels of severity of mental disorders. Methods:The authors have briefly reviewed the relevant current state of knowledge, challenges and the service and research response across four countries (Australia, Ireland, the U.K. and Canada) most active in this field.Results: 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. Conclusions:There is evidence that several countries are now engaged in transformation of youth mental health services and in evaluation of these initiatives.

Modeling the Interplay Between Psychological Processes and Adverse, Stressful Contexts and Experiences in Pathways to Psychosis: An Experience Sampling Study

“…[3][4][5] Unravelling the complex interplay between stress, affective and cognitive processes as basis for targeting these at an early stage, with the goal of preventing onset and achieving better outcomes of psychosis, is of public health importance. [8][9][10][11][12] Recently, the interplay between affective disturbances and stressful contexts and experiences in daily life (including stressful events, activities, and social situations) that may be underlying the development of PE has received much attention. [12][13][14][15][16] It has been repeatedly suggested that emotional reactivity to such routine daily hassles and minor socioenvironmental stressors may be an important mechanism.…”

“That little doorway where I could suddenly start shouting out”: Barriers and enablers to the disclosure of distressing voices

“…An alternative approach is the "Headspace" model, which focuses on engaging young people with mental health services through integrated and coordinated specialist youth and carer-friendly services that address mental health, physical health, work/study, or substance misuse (Malla et al, 2016;McGorry et al, 2007). An online support service also allows young people to access professional help and advice (Malla et al, 2016;McGorry et al, 2007). The findings from this study suggest that public awareness of voice hearing could be promoted through a model similar to the Headspace model.…”

Youth services: the need to integrate mental health, physical health and social care

“…As Malla et al [3] report in their review, less than 30 % of young people seek help for mental disorders. Long delays of several years are typical, especially for those with anxiety, mood and substance use disorders and for those with early age of onset [4].…”

“…From attending a familiar service where one is known, the young person must move to an unfamiliar service where one is expected to behave like an adult. Thus those most at risk of development of new and secondary disorders, at a stage of their life with multiple societal and personal challenges, are presented with disjointed and often confusing array of services [3].…”

“…Services need to respond so that young people with mental disorders can be identified early and provided with age-appropriate care that extends from early adolescence to young adulthood. Some headway has made and Malla et al [3] review the developments in youth mental health in four countries: Australia, Ireland, the UK and Canada. The Australian model is one of enhanced primary care for 12-25-year-olds, with general practitioners co-located or networked with mental health workers, drug and alcohol services and educational and vocational specialists.…”