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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.

Published in: Health & Medicine
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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. Thank you