Dr Rickwood & Dr Greenwood - Research in Youth Mental Health


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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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  • Dimensional vs categorical
  • Mathers 1999 – Australian data
  • Australian data 2007
  • 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.
  • Dr Rickwood & Dr Greenwood - Research in Youth Mental Health

    1. 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
    2. 2. Where is the evidence?
    3. 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)
    4. 4. We know what doesn’t work…
    5. 5. The spectrum model of illness
    6. 6. Disease Burden across Age (McGorry, 2007)
    7. 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)
    8. 8. Complex and confusing pathways (Farmer 2003)
    9. 9. ‘The system is weakest where it should be strongest’ (McGorry 2007)
    10. 10. Transitions are problematic (Singh 2007)
    11. 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. 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 - ???
    13. 13. Pulling the evidence together
    14. 14. 2nd IAYMH Conference Brighton 2013
    15. 15. What works and whats new in youth services? Crawley Pathfinder Service
    16. 16. Headspace - Australia
    17. 17. Youth space - Birmingham
    18. 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. 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. 20. Evaluation (Galway) Service type (n=503) information/brief contact case consultation specific problem/brief intervention longer term goals group work
    21. 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. 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. 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. 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. 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. 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. 27. Where next: Developing the evidence base? What do we need to show to keep this going? Economic and outcomes evaluation
    28. 28. www.sussex.ac.uk/spriglab Thank you