Transcript Document
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 Studies of views of young people, who have not used mental health services. (9936 young people questionnaires, 238 qualitative) study Biddle 2004 setting general popn age range 16-24 gend er ethnicity sampling number study design method B n/k random 3004 quant questionnaire Biddle 2006 general popn 16-24 B mixed stratified 22 qual interview Biddle 2007 gen pop& distressed young people 16 - 24 B ? selfselected 23 qual interview Fortune 2008 Adolescents views school 15 - 17 B ? ? 5293 mixed questionnaire - selfreport grounded theory open coding system, grounded theory, Qrs Nvivo Fortune 2008 Help-seeking school 15-16 B range n/k 2954 qual questionnaire thematic focus group and questionnaire thematic in depth interview questionnaire thematic chi squared focus group/semi structured interview descriptive stats selfselected Fox 2007 school 11 to 16 B Neale 2009 Paul 2008 general popn general popn 14 to 22 B 14-16 B nk south asian, afrocaribb self ean selected mixed self selcted 13 to 16 b south asian/whit e stratified Randhawa 2007 school 415 (63 in focus groups) qual 35 qual 1129 mixed 95 mixed analysis t tests grounded theory And what they said, ordered by weight of evidence: findings <50% would attend CAMH if referred. Want choice, final say, want information before attending, want generic name NOT mental health CAMHS not visible, school main focus info, want confidentiality, accessibility, would not go to GP for mental health, seen as pill dispensers value school based approach, proactive counselling, little relevance of mental health services want counselling lack of trust, accessibility, want flexibility, outreach, cultural competence, technology in delivery low % 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 stigma of mental health self-harm: friends & family as support, barriers to help seeking overall weight of evidence high high medium medium medium medium low low 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 Buston 2002 Day Gordon 2009 Grealish 2005 Greco 2009 Hardy 2009 McKenzie 2006 Lester 2011 Mullan 2007 Naylor 2008 O'Reilly 2009 O'Toole 2004 Rani 2009 Rother 2004 Sinclair 2005 Singh 2010 Storey 2005 Taylor 2007 Teggart 2006 Walker 2010 Woolfson 2008 Walsh 2011 setting age range ethnicity sampling number study design mental health 14-20 whote british NK 32 qual mental health 09 to 14 white UK randomised 11 qual mental health 7 to 17 nk self-selected 15 mixed mental health adolescents and nk carers ? 5 mixed mental health 7 to 16 nk self-selected 18 mixed mental health 16- 30 white british, 1 black none African 10 qual mental health nk ? ? 4 qual mental health 14-35 mixed self selected 63 qual mental health 12 to 25 nk random 51 mixed prison mean 14.6 mixed self selected 20 qual mental health - homeless 15 to 22 mixed stratified 25 qual mental health 17 - 49 BME 28.2% self-selected 12 qual mental health 13-17 NK self selected 7 Qual mental health to 28 n/k self selcected 6 qual community1 16-25 NK purposive 20 qual mental health transition mixed stratified 154 referrals, mixed 11 SU A&E 16 - 22 nk self-selected 74 qual mental health, homeless 16 - 23 nk self-selected 19 qual mental health 14 - 20 nk self-selected30 (11 focusqual group) mental health nk nk nk 7 qual mental health, psychology 12 to 15 service nk none 8 qual YOS 10 to 18 nk ? 44 (6 interviews) mixed method analysis semi-structured grounded theory and NU qual thematic interview content analysis, ?Nvivo questionnaire and diary log data matrices interview thematic analysis interview thematic grouping review of files, questionnaire, content interview analysis interview Charmaz's constructive t focus group, interview thematic content, NUD*I interview thematic interview (semi-structured) discourse analysis focus group with control group phenomenological and independent rese semi-structured framework approachanal semi structured thematic interview thematic using grounded interview, case note survey Nvivo constant comparat interview nk interview Nvivo, thematic analysis questionnaire, focus group thematic analysis focus group, independent researchers nk focus group thematic analysis self-report questionnaires, interview thematic analysis, SPSS And what they said, ordered by weight of evidence findings EI better than inpatient or a&E youth focused workers, flexibility, inclusive, commuity based, telling story too many times, lots of worries, continuity, include family, want to be listened to, not just medication, want continuity, support for carers, confidentiality, time to build relationship, trust deaf service, telemedicine genuineness of worker, trust hard won, flexibility, outreach, explanations, proof of commitment outreach, practical help, information, communication, prefer home based treatment, causes distress to family and sibs self-harm: importance of social networks integrated service-provision negative view of CAMH information sharing, patient information, self referral barriers to access patient information telemedicine social needs come first problems with service provision continuity stigma, barriers to engagement accessibility, peer support, school info, GP not helpful, counsellors nice but no help, trusted staff, continuity, someone outside the family but not secondary care, information, more help in A+E, transition planning, joint working, flexibility want new service overall weight of evidence high high med med medium medium medium medium medium medium medium medium low low low low low low low low low low Key themes: flexibility, continuity, inclusion, family work, community based, information Research Into Practice • BLOCKS: SOLUTIONS: • Research said: CAMH and AMH barriers incl. Managerial/funding streams Scoping meetings with CAMHS Development of working group with CAMH, Consultants and Managers using local data • Research said: Lack of young people involved in service development To Set up a working party (YPPI) to develop a young person advisors group (U-think) • Trust Transformation/CSIP Engage Senior Managers/Board, trust 5 yr plan and under 17’s • Lack of stakeholder commitment across agencies Regional network and stakeholder conference •But what happens when it becomes a reality?