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

Hetrick, Sarah; Bailey, Alan P; Smith, Kirsten E.; Malla, Ashok; Mathias, Steve; Singh, Swaran P.; O’Reilly, Aileen; Verma, Swapna; Benoit, Laelia; Fleming, Theresa; Moro, Marie Rose; Rickwood, Debra; Duffy, Joseph; Eriksen, Trissel; Illback, Robert J.; Fisher, Caroline A.; McGorry, Patrick D.

doi:10.5694/mja17.00694

Cited by 176 publications

(257 citation statements)

References 68 publications

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“…Thus, having services that span the age range of 12–25 years and are tailored to a diversity of youth needs can help to make the transition process smoother [57]. This aligns with the international movement toward integrated youth MHSU and wellness centers [58, 59]. Of course, youth are not a homogenous group, and different youth may have different preferences.…”

Section: Discussionmentioning

confidence: 99%

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

Hawke

Mehra

Settipani

et al. 2019

BMC Health Serv Res

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Background 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. Methods 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. 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. Conclusion 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. Electronic supplementary material The online version of this article (10.1186/s12913-019-4066-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

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

Hawke

Mehra

Settipani

et al. 2019

BMC Health Serv Res

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“…These services are showing promising results, with better access to services, high acceptability to patients and families, and some enhancement of symptomatic and functional outcomes 21. By capturing the various pathways to a range of disorders, transdiagnostic services increase capacity to capture a wider range of lower risk cases.…”

Section: Early Intervention: the Evidencementioning

confidence: 99%

Early intervention in youth mental health: progress and future directions

McGorry

Mei

2018

Evid Based Mental Health

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187

161

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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.

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“…The service is not triaged based and is available to any young person requiring mental healthcare. This is a key strength of the model as it is able to effectively manage a high volume of cases through its broad-based entry, which is not possible through narrow approaches such as UHR clinics and traditional child and adolescent mental health services 22. The number of headspace clients with subthreshold psychotic symptoms ranges from 23% (based on preliminary findings from a large trial of UHR cases)23 to 38% 24.…”

Section: Transition and Its Limitationsmentioning

confidence: 99%

Ultra-high-risk paradigm: lessons learnt and new directions

McGorry

Mei

2018

Evid Based Mental Health

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Within the embryonic early psychosis field in the early 1990s, the conceptualisation and definition of an at-risk or ultra-high-risk (UHR) mental state for psychosis was a breakthrough which transformed the clinical and research landscape in psychiatry. Twenty-five years later, we have a new evidence base that has illuminated the neurobiology of the onset phase of psychotic disorder, delivered Cochrane level 1 evidence showing that the onset of full-threshold sustained psychotic disorder can be at least delayed, and is paving the way to a new generation of transdiagnostic research. Here, we document the contribution of the UHR approach to understanding the underlying mechanisms of psychosis onset as well as the long-term outcomes. Particularly, we highlight that psychosis onset can be delayed in those meeting UHR criteria and that these criteria have a higher valence for subsequent psychotic disorders and some valence for persistent non-psychotic syndromes. Critiques have helped to identify some of the limitations of this paradigm, which are acknowledged. These include evidence that psychotic disorders can emerge more acutely and from other, as yet undefined, precursor states. Rather than defending, or alternatively questioning the value of, the UHR approach, we propose a broader, transdiagnostic staging model that is consistent with the pluripotent and variably comorbid trajectories for mental disorders. This approach moves beyond psychosis to capture a wider range of subthreshold symptoms and full-threshold disorders, thus enhancing prediction for the emergence and progression of a range of mental disorders, as well as providing new avenues for early intervention and prevention.

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

Cited by 176 publications

References 68 publications

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

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

Early intervention in youth mental health: progress and future directions

Ultra-high-risk paradigm: lessons learnt and new directions

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