The Impact of Community Mental Health Programs for Australian Youth: A Systematic Review

Smith³

et al. 2023

Preprint

Self Cite

Background There has been limited focus on understanding the barriers and facilitators to meeting the broader psychosocial needs of young people with mental illness, from the perspectives of young people themselves. This knowledge is required to advance the local evidence base and inform service design and development. Therefore, the aim of this qualitative study was to explore young people’s (10–25 years) and carers’ experiences of mental health services, focusing on the barriers and facilitators to services supporting young people’s psychosocial functioning.Method Young people with living experience of mental illness were involved in all stages of this research. Semi-structured interviews were conducted with 32 young people aged 10–25 years with experience of mental illness, and 29 carers (12 were parent-child dyads). Qualitative analysis was guided by the Social-Ecological Framework to identify barriers and facilitators at the individual (young person/carer level), interpersonal, and service/systemic level.Results Young people and carers identified eight barriers and six facilitators across the various levels. Barriers included, at the individual level: (1) the complexity of young people’s psychosocial needs and (2) lack of awareness/knowledge of services available; at the interpersonal level: (3) negative experiences with adults and (4) fragmented communication between services and family; and at the systemic level: (5) lack of services; (6) long waiting periods; (7) limited service accessibility; and (8) the missing middle. Facilitators included, at the individual level: (1) education for carers; the interpersonal level: (2) positive therapeutic relationships and (3) carer advocacy/support; and systemic level: (4) flexible or responsive services, (5) services that address the psychosocial factors; and (6) safe service environments.Conclusions This study identified lived-experience recommendations for public mental health policy and practice, including service design and development. To better enhance their psychosocial functioning, young people and carers want lived-experience workers to provide practical wrap-around support, and they want mental health services that integrate health and social care, and are flexible, responsive and safe. These findings will inform the co-design and development of a new community-based youth psychosocial service to support the psychosocial wellbeing of young people experiencing severe mental illness.

Section: Discussionmentioning

confidence: 99%

“I literally had no support”: Barriers and facilitators to supporting the psychosocial wellbeing of young people with mental illness in Tasmania, Australia

Smith³

et al. 2023

Preprint

Self Cite

“…These include New Zealand’s Youth One Stop Shops [ 27 ], Youth Wellness Hubs in Canada [ 28 ], and Jigsaw in Ireland [ 29 ], which provide clinical mental health support and social care services embedded in a single community-based setting delivered by a multidisciplinary team, aiming to ameliorate care fragmentation, service navigation and accessibility barriers for youth. However, there is a lack of such models that have been implemented and evaluated within Australia [ 30 ]; Orygen Youth Health in Victoria recently launched psychosocial support packages for young people aged 16–24 years experiencing moderate to severe mental illness [ 31 ]. It is clear that greater integration within the Tasmanian youth mental health sector is required so that young people have access to both clinical and social care support to enhance their psychosocial wellbeing.…”

Section: Discussionmentioning

confidence: 99%

“I literally had no support”: barriers and facilitators to supporting the psychosocial wellbeing of young people with mental illness in Tasmania, Australia

Child Adolesc Psychiatry Ment Health

Smith

et al. 2023

Self Cite

Background There has been limited focus on understanding the barriers and facilitators to meeting the broader psychosocial needs of young people with mental illness from the perspectives of young people. This is required to advance the local evidence base and inform service design and development. The aim of this qualitative study was to explore young people’s (10–25 years) and carers’ experiences of mental health services, focusing on barriers and facilitators to services supporting young people’s psychosocial functioning. Methods This study was conducted throughout 2022 in Tasmania, Australia. Young people with lived experience of mental illness were involved in all stages of this research. Semi-structured interviews were conducted with 32 young people aged 10–25 years with experience of mental illness, and 29 carers (n = 12 parent–child dyads). Qualitative analysis was guided by the Social-Ecological Framework to identify barriers and facilitators at the individual (young person/carer level), interpersonal, and service/systemic level. Results Young people and carers identified eight barriers and six facilitators across the various levels of the Social-Ecological Framework. Barriers included, at the individual level: (1) the complexity of young people’s psychosocial needs and (2) lack of awareness/knowledge of services available; at the interpersonal level: (3) negative experiences with adults and (4) fragmented communication between services and family; and at the systemic level: (5) lack of services; (6) long waiting periods; (7) limited service accessibility; and (8) the missing middle. Facilitators included, at the individual level: (1) education for carers; at the interpersonal level: (2) positive therapeutic relationships and (3) carer advocacy/support; and at the systemic level: (4) flexible or responsive services, (5) services that address the psychosocial factors; and (6) safe service environments. Conclusions This study identified key barriers and facilitators to accessing and utilising mental health services that may inform service design, development, policy and practice. To enhance their psychosocial functioning, young people and carers want lived-experience workers to provide practical wrap-around support, and mental health services that integrate health and social care, and are flexible, responsive and safe. These findings will inform the co-design of a community-based psychosocial service to support young people experiencing severe mental illness.

“…Participants were aged between 1 and 9 years to address the lack of synthesis focused on young children (i.e. prior to adolescence), as a recent Australian review has previously examined mental health programmes for young people aged 10 years and over (Savaglio et al, 2022). This age range encompasses national and international definitions of early childhood (Department of Health and Human Services, 2020), and includes the years prior to the onset of adolescence (UNICEF, 2022).…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

“…However, there is limited synthesis of research conducted in the Australian context. While a recent Australian review found that community-based mental health programmes for adolescents and young people aged 10–25 years experiencing mental illness can alleviate internalising symptomatology (Savaglio et al, 2022), the overall impact of targeted programmes for younger Australian children specifically, remains unclear. Furthermore, the majority of the existing local and international literature focuses on universal mental health programmes, particularly in the school setting (e.g.…”

mentioning

confidence: 99%

Targeted community-based programmes for children’s mental health: A systematic review and meta-analysis of the Australian literature

O’Donnell

et al. 2022

Aust N Z J Psychiatry

Self Cite

Objective: No synthesis of the Australian evidence regarding targeted prevention and early intervention for mental health concerns among young children exists. This review aimed to (1) describe the types of targeted community-based mental health programmes evaluated in Australia to support children aged 1–9 years exhibiting internalising and/or externalising symptoms and (2) examine their impact on children’s internalising and externalising symptoms and disorder diagnosis. Method: A systematic review and meta-analysis was conducted (PROSPERO: CRD42021255257). Four databases (PsycINFO, PsycArticles, MEDLINE and CINAHL) were searched for Australian studies published in the past 10 years that quantitatively evaluated the impact of a targeted programme on children’s mental health. The National Institute of Health Quality Assessment Tools were used to evaluate the study quality. Results: Forty-two studies were included; the majority (67%) were medium quality. The mean sample size was 142 (SD = 170), children’s average age was 5.78 years (SD = 2.44) and 58% were male. Aboriginal and Torres Strait Islander children were underrepresented. Studies evaluated 16 programmes that targeted (1) externalising symptoms ( n = 20 studies, n = 6 programmes), (2) internalising symptoms ( n = 14 studies, n = 7 programmes) or (3) both, termed transdiagnostic programmes ( n = 8 studies, n = 3 programmes). Externalising programmes achieved a significant moderate mean reduction in externalising behaviours (standardised mean differences = −0.56), internalising programmes yielded a small mean improvement in anxiety symptoms (standardised mean differences = −0.25) and 57% reduced odds of anxiety disorder diagnosis. Evidence supporting transdiagnostic programmes was inconclusive. Conclusion: Parenting-focused programmes targeting young children’s internalising or externalising behaviours have the largest local evidence base supporting their effectiveness. Limitations include a lack of engagement with fathers, triangulation of outcomes, homogeneity and implementation reporting. Greater implementation and evaluation of community-driven integrated and systemic approaches that identify, engage and support Australia’s most disadvantaged cohorts of young children and their families are needed.