Abstract
The onset of mental disorders often occurs in adolescence or young adulthood, but the process of early diagnosis and access to timely effective and appropriate services can still be a challenge. The goal of this paper is to describe a pilot case of implementation of the ultra-high-risk (UHR) paradigm in six Italian departments of mental health employing an integrated approach to address clinical practice and service organization for youth in a broader preventive perspective. This approach entailed the integration of the UHR paradigm with a service provision model which prioritizes prevention and the promotion of local community coalitions to improve youth service accessibility. The multicenter Italian project “Integrated programs for recognition and early treatment of severe mental disorders in youths” funded by the National Centre for Disease Prevention and Control (CCM2013 Project) implemented in three Italian regions will be described. As a result of synergic actions targeting accessibility of young individuals to innovative youth mental health teams, a total of 376 subjects aged 15–24 years were recruited by integrated youth services within 12 months. Subjects have been screened by integrated multidisciplinary mental health youth teams employing standardized procedure and evidence-based clinical assessment instruments for at-risk mental states in young subjects [e.g., Comprehensive Assessment of At-Risk Mental States (CAARMS)]. Considering the three UHR categories included in CAARMS, the percentage of UHR subjects was 35% (n = 127) of the sample. In conclusion, future strategies to improve the organization of youth mental health services from a wider preventive perspective will be proposed.
Highlights
The goal of this paper is to describe a pilot case of implementation of the ultra-high-risk (UHR) paradigm in six Italian departments of mental health employing an integrated approach to address clinical practice and service organization for youth in a broader preventive perspective
The aim of this paper is to describe a pilot case of implementation of youth mental health services within the Italian framework according to three key elements: 1) enhanced secondary prevention-oriented actions including the screening of at-risk mental states in young subjects through standardized procedures and instruments; 2) higher services’ accessibility of young individuals with sub-threshold symptoms with specific attention to vulnerable or at-risk groups; and 3) the establishment of youth mental health teams with high level of integration between the adult and child–adolescence mental health services
Patients’ referral to the project occurred through diversified ways: first, young subjects could be referred from the community coalition stakeholders; second, patients could be referred from other mental health services; third, they could have direct access to the project
Summary
The Italian project “Integrated programs for recognition and early treatment of severe mental disorders in youths” was funded by the National Centre for Disease Prevention and Control (CCM2013 Project). Its aims included to ensure effective evidence-based clinical assessment of ARMS in young subjects (15–24 years old) and to encourage youths’ participation in different community organizations through the Community Coalition model [19]. It aimed at improving the integration between child–adolescent and adult mental health services through the creation of integrated and multidisciplinary youth mental health teams [22]. Those locations were separated from the routine mental health service sites and hospitals, and possibly located near public areas visited by young individuals (e.g., parks, schools). Exclusion criteria for the UHR assessment were: age not included in the range 15–24 and the presence of mental retardation (IQ score less than 80)
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