The Youth Mental Health Network (YMHN) is driven and made up of a range of individuals and groups that are passionate about improving the mental health of young people, regardless of their background.
The Youth Mental Health Network's vision is to improve the provision of youth mental health services by harnessing and fostering commitment to evidence based youth mental health services, in their various forms.
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Dr Rickwood & Dr Greenwood - Research in Youth Mental Health
1. Research Evidence for
Service Improvement in
Youth Mental Health
YMHN Conference 24th June 2013
Rick Fraser – Sussex Partnership NHS Foundation Trust
Kathy Greenwood - Sussex Partnership NHS Foundation Trust
3. What we do know
• 1 in 4 young people between 15-24 will experience a mental
disorder in any 12 month period
• 15 - 24 years old is the peak period for the onset of mental
disorders (75%)
• Mental health issues are responsible for 65 - 70% of Burden of
Disease for young people aged 15-24
• Mental and substance use disorders frequently coexist (70% of
help seeking cohorts)
• Pathways for young people to access health resources are limited
as use of standard GPs is under-represented in this age group
• Although most young people experience recovery from symptoms
of mental disorders, there is a significant negative impact on
longer term vocational pathways and economic participation
(Birchwood, Singh & McGorry, 2013)
7. MH Prevalence /Service Use Gap
greatest for young people
0
5
10
15
20
25
30
16-24 25-34 35-44 45-54 55-64 65-74 75-85
Percent
Age
Prevalence
Service Use
(McGorry, 2007)
11. Rationale for Youth Services
Adult mental health disorders begin in adolescence
Early intervention model
Preventive strategies
Developmental perspective
Access/engagement/retention
Appropriate setting/clinical staff/service configuration
Family involvement
Social/vocational
Economic
Reform
12. Evidence for Youth Services
Adult mental health disorders begin in adolescence – Insel
2005, Jones 2013
Early intervention – Mihalopoulos 2009, McGorry 2013
Preventive strategies – Yung 2013, Stallard 2013, Chanen 2013
Developmental perspective – Lamb 2013
Access/engagement/retention – Singh 2009
Appropriate setting/clinical staff/service configuration –
McGorry 2009
Family involvement – Bebbington 2011
Social/vocational – Killackey 2010
Economic – Knapp & McCrone 2010 (2013)
Reform - ???
18. Ireland
Youth frie
Early
Accessible
Strengths/Resilience based
Communities, Schools
Mental Health Services,
young people, youth workers
doctors, psychologists, families,
Psychiatrists, sports coaches
Learning Network
Youth Café
Open Door sessions
Drop in/outreach
Jigsaw wraparound
Peer mentoring
Challenging Stigma
Health promotion
Youthreach (schools)
19. Somewhere to turn to, someone to talk to..
Vision
young people
connected and
resilient
Values
Respect for and
support for
good mental
health
Mission
Changing thinking
(through advocacy/
involvement/resear
ch/evaluation
20. Evaluation (Galway)
Service type (n=503)
information/brief
contact
case consultation
specific problem/brief
intervention
longer term goals
group work
21. Key features
• Youth participation
• Holistic, optimistic, preventative, shared decision-making
(risk/benefit)
• EI, social inclusion and vocational outcome target
• Reflect mental health epidemiology & developmental
youth culture
• Eliminate discontinuities and
• Promote seamless service links
McGorry, Bates and Birchwood 2013
22. Phase 1 focus groups/interviews
Young Service
users
N=22
Young People
N=22
Siblings/Parents
N=24
Sussex, Surrey and Kent
N=68 people
Early Youth Engagement in FEP (EYE)
23. Phase 1 engagement outcomes
Facilitators and Barriers to engagement
Barrier and Facilitator themes
Commun-
ication
servicetoserviceuser/
carer
Lackofinform-ation
Social
Family
Friend
Serviceusers
Stigma-barrier
Media-facilitator Mental health
service
serviceitself
medication
hosptial
Mental health Staff
Action
Attitude
Knowledge
Personal experience
MentalHealth
Behaviour
PersonalQualities
Socialenvironment
24. Phase 1 – Barriers/Facilitators
Information
“not knowing what will happen when I get help and what options I have…”
“Knowing that I am not alone and that there are millions of people that have the same
illness and people can help and how they can help.”
Fear of the service
“Being labelled as mental and losing control of my own life in terms of reliance on
drugs.”
Friends
“I think they might have helped me to engage with the services because they
reminded me that I had a place to get back to if you see what I mean like I’ve got a
goal you know.”
Intervention choices
“there are, you know, it’s also proven by experiments that you know human touch
releases Oxytocin, exercise releases endorphins”
25. Phase 2 Delphi to intervention?
EYE
model?
Myth busting &
informed
choice
intervention
information
booklets
Carer/School
Packs
Engagement
website
Improve GP
links
Active social
engagement
Friends, family,
peer worker
Transparent
Goal-focussed
engagement
Increased
choice of
activities
26. Crawley Youth Pathfinder
Started November 2012
1 team lead, 2 key workers
Training in conjunction with young people and based on
their responses
Approximately 30 young people seen to date
Most provided pathfinder support and guidance
10% supported to obtain specialist mental health
services
27. Where next: Developing the evidence base?
What do we need to show to keep this
going?
Economic and outcomes evaluation
12-25, accessible, one stop shop, enhanced primary care, physical health service (a stigma free access point) – focus on mh, drugs and alc, primary care and vocational/educational. Also community awareness, on-line support, schools-based interventions. 93% of young people satisifed, and as many men as women seen. Link to Orygen Youth Health for more complex problems (psychosis, Mood disorders and BPD)
In strategic partnership with the princes trust. 16-25 year olds, offered brief CBT through youth access teams, with option to access intensive care streams in psychosis, eating disorders, ADHD, forensic as well as public youth mental health interventions and evaluation.