Developing Youth mental health services

The Story

• May 2010: Killarney Youth Summit: Young person inclusive, International declaration on Youth mental health

• Youth Conference Birmingham (Oct 2010)

• CLARHC Initial Problem Solving Session: Systematic Review of Young peoples Views on Mental Health in Britain

• 10 years of lobbying by youth movement……“How many times do we have to tell you” (NAC)

Why Youth Mental Health?

• 75% of mental health disorders commence before 24 yrs of age (Kessler et al 2005)

• “the surge of new morbidity between the ages of 15 and 25 is paired with the worst access to services, the system is weakest where it needs to be strongest.” (McGorry,2009)

• Most transitions are poorly planned, poorly executed and poorly experienced (Singh et al 2010)

Why a systematic review?

•How good is the evidence?

•Whose evidence?

•Relevance to UK?

•Cornerstone of any proposed service developments

“A systematic review of studies of young peoples

views of services available for people with mental

health problems!”

• Research question• Research protocol (SCIE)• Title and abstract screening• Paper screening• Hand searches• Quality evaluation / data extraction• Initial findings• Final narrative• Write up and submission

Initial findings

study settingage range

gender ethnicity sampling number study design method analysis

Biddle 2004 general popn 16-24 B n/k random 3004quant questionnaire t tests

Biddle 2006 general popn 16-24 B mixed stratified 22qual interviewgrounded theory

Biddle 2007

gen pop& distressed young people 16 - 24 B ?

self-selected 23qual interview

grounded theory

Fortune 2008 Adolescents views school 15 - 17 B ? ? 5293mixed

questionnaire - self-report

open coding system, grounded theory, Qrs Nvivo

Fortune 2008 Help-seeking school 15-16 B range n/k 2954qual questionnaire thematic

Fox 2007 school 11 to 16 B nkself-selected

415 (63 in focus groups) qual

focus group and questionnaire thematic

Neale 2009 general popn 14 to 22 B

south asian, afrocaribbean

self selected 35qual in depth interview thematic

Paul 2008 general popn 14-16 B mixed self selcted 1129mixed questionnaire chi squared

Randhawa 2007 school 13 to 16 b

south asian/white stratified 95mixed

focus group/semi structured interview

descriptive stats

Studies of views of young people, who have not used mental health services. (9936 young people questionnaires, 238 qualitative)

And what they said, ordered by weight of evidence:

findings overall weight of evidence<50% would attend CAMH if referred. Want choice, final say, want information before attending, want generic name NOT mental health highCAMHS not visible, school main focus info, want confidentiality, accessibility, highwould not go to GP for mental health, seen as pill dispensers mediumvalue school based approach, proactive counselling, little relevance of mental health services mediumwant counselling mediumlack of trust, accessibility, want flexibility, outreach, cultural competence, technology in delivery mediumlow % seek help from GP for mental health, less than 1 in 5 with suicidal thoughts go to GP, men higher threshold severity before seeking help lowstigma of mental health lowself-harm: friends & family as support, barriers to help seeking low

Key themes: school main source support/information. Do not see GP or mental health services as relevant for mental health problems

Studies of views of young people, who have used mental health

services (total n=625)study setting age range ethnicity sampling number study design method analysisBuston 2002 mental health 14-20 Bwhote british NK 32 qual semi-structured grounded theory and NUDIST packageDay mental health 09 to 14 Bwhite UK randomised 11 qual qual thematicGordon 2009 mental health 7 to 17 Bnk self-selected 15 mixed interview content analysis, ?NvivoGrealish 2005 mental health adolescents and carersBnk ? 5 mixed questionnaire and diary log data matricesGreco 2009 mental health 7 to 16 Bnk self-selected 18 mixed interview thematic analysisHardy 2009 mental health 16- 30 Bwhite british, 1 black Africannone 10 qual interview thematic groupingMcKenzie 2006 mental health nk B? ? 4 qual review of files, questionnaire, interviewcontent analysisLester 2011 mental health 14-35 Bmixed self selected 63 qual interview Charmaz's constructive theory methodoloyMullan 2007 mental health 12 to 25 Bnk random 51 mixed focus group, interview thematic content, NUD*ISTNaylor 2008 prison mean 14.6 Bmixed self selected 20 qual interview thematicO'Reilly 2009 mental health - homeless15 to 22 Bmixed stratified 25 qual interview (semi-structured) discourse analysisO'Toole 2004 mental health 17 - 49 BBME 28.2% self-selected 12 qual focus group with control group and independent research teamphenomenologicalRani 2009 mental health 13-17 BNK self selected 7 Qual semi-structured framework approachanalusisRother 2004 mental health to 28 fn/k self selcected 6 qual semi structured thematicSinclair 2005 community1 16-25 BNK purposive 20 qual interview thematic using grounded theorySingh 2010 mental health transition Bmixed stratified 154 referrals, 11 SUmixed interview, case note survey Nvivo constant comparative methodStorey 2005 A&E 16 - 22 Bnk self-selected 74 qual interview nkTaylor 2007 mental health, homeless16 - 23 Bnk self-selected 19 qual interview Nvivo, thematic analysisTeggart 2006 mental health 14 - 20 Bnk self-selected30 (11 focus group)qual questionnaire, focus group thematic analysisWalker 2010 mental health nk nknk nk 7 qual focus group, independent researchersnkWoolfson 2008 mental health, psychology service12 to 15 Bnk none 8 qual focus group thematic analysisWalsh 2011 YOS 10 to 18 Bnk ? 44 (6 interviews)mixed self-report questionnaires, interviewthematic analysis, SPSS

And what they said, ordered by weight of evidencefindings overall weight of evidenceEI better than inpatient or a&E highyouth focused workers, flexibility, inclusive, commuity based, telling story too many times, lots of worries, continuity, include family, highwant to be listened to, not just medication, want continuity, support for carers, medconfidentiality, time to build relationship, trust meddeaf service, telemedicine mediumgenuineness of worker, trust hard won, flexibility, outreach, explanations, proof of commitment mediumoutreach, practical help, information, communication, prefer home based treatment, causes distress to family and sibs mediumself-harm: importance of social networks mediumintegrated service-provision mediumnegative view of CAMH mediuminformation sharing, patient information, self referral mediumbarriers to access mediumpatient information lowtelemedicine lowsocial needs come first lowproblems with service provision lowcontinuity lowstigma, barriers to engagement lowaccessibility, peer support, school info, GP not helpful, counsellors nice but no help, lowtrusted staff, continuity, someone outside the family but not secondary care, information, more help in A+E, lowtransition planning, joint working, flexibility lowwant new service low

Key themes: flexibility, continuity, inclusion, family work, community based, information

Research Into Practice• BLOCKS:• Research said: CAMH and AMH

barriers incl. Managerial/funding streams

• Research said: Lack of young people involved in service development

• Trust Transformation/CSIP

• Lack of stakeholder commitment across agencies

SOLUTIONS:Scoping meetings with CAMHS

Development of working group with CAMH, Consultants and Managers using local data

To Set up a working party (YPPI) to develop a young person advisors group (U-think)

Engage Senior Managers/Board, trust 5 yr plan and under 17’s

Regional network and stakeholder conference

•But what happens when it becomes a reality?