Politics on the mind: assessing the state of mental health after the election

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

This study examined the relationship of age and gender with risk of arrest among adolescents and young adults who were intensive adolescent users of public mental health services. Data were obtained from the Massachusetts Department of Mental Health (DMH) and juvenile and criminal courts. Participants were youths receiving DMH adolescent case management services sometime in 1994-1996 who were born between 1976 and 1979 (781 males and 738 females). They were cross-matched to document arrests between age seven and 25. The study examined age at first arrest, age-specific risk, and the relationship between arrest history and arrest risk by gender and age. Most males (69%) and almost half the females (46%) were arrested by age 25. First arrest was most common before age 18. As in the general population, males' arrest patterns were more concerning than those of females, although patterns were of concern in both groups. Most female arrestees had multiple arrests, many as adults. No gender differences were observed for several factors, including risk of first arrest over age 18. Risk was far greater for those arrested in the previous year than for those never arrested. Findings justify concerns of public mental health systems regarding justice system involvement of adolescent clients. Risk of first arrest was significant from early adolescence through age 24, indicating a need for arrest prevention into young adulthood. The heightened arrest risk at all ages among those who were recently arrested demarcates a population in need of immediate intervention.

Child mental health services in England: a continuing crisis

National Health Service Child and Adolescent Mental Health Services are specialist teams that assess and treat children and young people with mental health problems. Overall, 497,502 children were referred to National Health Service Child and Adolescent Mental Health Services between 2020 and 2021, and almost one-quarter of these referrals were not successful. Unsuccessful referrals are often distressing for children and families who are turned away usually after a long waiting period and without necessarily being redirected to alternative services. The process is also costly to services because time is wasted reviewing documents about children who should have been referred for alternative help and may prevent young people who need specialist help receiving it in a timely way. The overarching aim of this study was to understand what the problems are with Child and Adolescent Mental Health Services referrals and identify solutions that could improve referral success. A key objective was to talk widely with young people and families, people working in Child and Adolescent Mental Health Services and mental health professionals so that we could understand fully what the problems were and how we might develop their solutions. We gathered individual pseudonymised patient data from nine Child and Adolescent Mental Health Services, and referral data from four National Health Service Trusts to look at what data are available and how complete it is. We report wide variation in the numbers of referrals between and within Trusts and in the proportions not being successful for treatment. Data on factors such as age and gender of children and young people referred into Child and Adolescent Mental Health Services and who made the referral are routinely collected, but ethnicity of the children and young people's reason for referral are not as well collected across all Trusts. We also conducted focus groups with over 100 individuals with differing perspectives on the Child and Adolescent Mental Health Services referral process (children and young people, parents and carers, key referrers, and Child and Adolescent Mental Health Services professionals) and asked about current difficulties within the referral process, as well as potential solutions to these. Problems identified included: confusion about what Child and Adolescent Mental Health Services is for, that is what it does and does not provide; and lack of support provided during the referral process. Possible solutions included: streamlining the referral pathways through digital technologies with accompanying standardisation of referral forms for National Health Service Child and Adolescent Mental Health Services; and early ongoing communication throughout the referral 'journey' for the referrer/family. Should consider the standardisation of and improvement to the Child and Adolescent Mental Health Services referral process following the recommendations outlined in this project. This study is registered on ClinicalTrials.gov with the identifier: NCT05412368. https://clinicaltrials.gov/study/NCT05412368. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR131379) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 21. See the NIHR Funding and Awards website for further award information.

Background: There is general consensus that child and adolescent mental health services in low- and middle-income countries have an urgent need to be strengthened. However, this require not only a universal understanding of services and service needs, but also in-depth local knowledge to inform relevant service strengthening. This study sought to explore the perspectives of senior child and adolescent mental health service providers and policy-makers in one South African province to identify strengths, weaknesses, opportunities, and threats to child and adolescent mental health services.Methods: A qualitative study was conducted with 13 purposively sampled senior child and adolescent mental health service providers, senior managers, and policy-makers from the Western Cape Province, using a half-day multi-stakeholder workshop format. Verbal and written data were recorded and coded for analysis. Two independent raters performed thematic analysis.Results: The comprehensive bio-psycho-social approach and strong specialist child and adolescent mental health service units were identified as strengths. Limited capacity, workload demands, inadequate and inequitable resource allocation, poor implementation of early detection and preventative policies, and overall neglect of child and adolescent mental health services, were identified as weaknesses. Collaborative working between child and adolescent mental health and pediatric services, and increased provincial government (Department of Health) involvement, were identified as potential opportunities to develop and strengthen child and adolescent mental health services. Silo working of agencies, societal stressors, inadequate infrastructure and other resources, and lack of dedicated funding for child and adolescent mental health, were identified as threats to the development of services.Conclusions: This analysis of strengths, weaknesses, opportunities, and threats reinforced the widespread neglect of child and adolescent mental health services in South Africa and highlighted areas for further research and advocacy. There is a clear need to explore the perspectives and experiences of service users and providers to generate comprehensive multi-stakeholder evidence that may identify positive "tipping points" for improvements and strengthening of child and adolescent mental health service delivery, training, and research.

Byline: P. Shastri Introduction The importance of psychological well-being in children and adolescent, for their healthy emotional, social, physical, cognitive and educational development, is well-recognized. There is now increasing evidence on the effectiveness of interventions to improve children's and adolescent's resilience, promote mental health and treat mental health problems and disorders. Mental health problems will contribute significantly to the global burden of disease in the 21st century, and for adolescents, mental health hurdles are already as common as some physical health problems such as asthma.[sup] [1] Clinical preoccupation of the available mental health professionals of the country and the delay of these professionals to spearhead work towards promotion, prevention, identification and early intervention in child mental health has been a major lacuna. There are limited child and adolescent mental health services in India. Mostly such services are restricted to urban areas. Access to mental health services for children with a mental, emotional or behavioural disorder is substandard, not provided early enough, in sufficient supply and accessible only to a fraction of children and adolescents. We currently have tertiary care centres which attend to mental illness in hospital setting. They are therapeutic in nature and aim to treat and rehabilitate back to society. However, large gap exists in the area of prevention, mental health promotion and early intervention programmes. Child Mental Health Policy and School Mental Health Programmes have provided excellent opportunity to enhance mental health programme for children and adolescents. Focus is rightly on preschool children and school based mental health programmes which will prevent and possibly promote positive mental health. It also ensures that it will reduce behaviour disorders in children and prevent adult psychopathology. Effectiveness of child mental health intervention programmes will surely help in addressing mental health disorders among adults. Even WHO identifies the treatment gap in mental health care. World Health Organisation, asserts that many people suffering from psychiatric illnesses remain untreated, although effective treatment exists. WHO report examines the extent of this gap between the prevalence and treatment of psychiatric disorders globally. One in every 5 child has a mental health issue. If we invest in identifying the problems early and intervene at the right time, it will be more cost effective, as we will be preventing further breakdown and avoid an adult treatment and rehabilitation programme which is much more expensive. As it is rightly said that Prevention is Better than Cure. It is possible to prevent the majority of behaviour disorders in preschool and school environment itself. The dire need is to stimulate long-term and sustained improvement in children's health, by setting standards for high quality integrated health and social care for children from before birth, right through to adulthood. And while doing this one of the main focus area has to be the mental health and psychological wellbeing of children and young people. In order to achieve desired outcomes one should embrace all those services that contribute to the mental health care of children and adolescents, whether provided by health, education, social services or other agencies. It is also crucial to partner with services whose primary function is not mental health care, such as GPs and schools. They can always contribute by offering general advice and treatment for less severe problems, contribute towards mental health promotion, identify problems early in their development, and refer to more specialist services. This is to explicitly acknowledge that supporting children and adolescents with mental health problems is not the responsibility of specialist services alone. …

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

Opportunities in mental health services research.

IntroductionTransition between health services is widely recognised as a problematic hurdle. Yet, the factors necessary for successful transition out of child and adolescent mental health services (CAMHS) as youth reach...

Autistic children and young people are at increased risk of mental health difficulties, but often face barriers when seeking help from Child and Adolescent Mental Health Services. This study aimed to (1) explore the experiences of parents/carers seeking help from Child and Adolescent Mental Health Services for their autistic child’s mental health difficulties, and (2) gain parents’ perceptions of the accessibility of Child and Adolescent Mental Health Services for their child. A mixed-methods survey design was used. In total, 300 parents/carers took part from across the United Kingdom. Quantitative data were analysed using descriptive statistics, and qualitative data using qualitative content analysis. Findings demonstrated ongoing struggles that parents/carers faced when seeking help from Child and Adolescent Mental Health Services. Those who were referred reported a lack of reasonable adjustments and offers of ineffective or inappropriate therapies. Ultimately, parents felt their child’s mental health difficulties either did not improve or declined to the point of crisis. However, there was a recognition that some professionals were kind and compassionate. There is a need for a more neuro-inclusive and personalised approach in Child and Adolescent Mental Health Services. Further research, funding and training are urgently needed to ensure support is accessible, timely and effective for autistic young people.Lay abstractAutistic children and young people are more likely to experience mental health difficulties than neurotypical peers, but also face more barriers when seeking help from Child and Adolescent Mental Health Services. Findings highlight the need for a more neuroaffirmative approach from the professionals themselves, in the adjustments offered, and in the therapies provided. Barriers to Child and Adolescent Mental Health Services for autistic children and young people include diagnostic overshadowing (i.e. assuming mental health difficulties are part of autism), high thresholds for assessment and a lack of professional knowledge about autism and care pathways. Healthcare policies should ensure that all Child and Adolescent Mental Health Services professionals receive neuroaffirmative training and that resources/funding are provided for appropriate adjustments and early support. There is also a need for further research and funding to develop and evaluate effective neuroaffirmative therapeutic interventions.

Leaving child and adolescent mental health services in the MILESTONE cohort: a longitudinal cohort study on young people's mental health indicators, care pathways, and outcomes in Europe

Child Protection and Mental Health

BackgroundResearch has shown a strong association between suicide and mental disorders, and people in contact with services for mental health and substance use are known to be at high risk of suicide. Still, few studies have previously described suicide among young people in contact with Child and Adolescent Mental Health Services.AimThe aim of this study is to examine the prevalence of contact and suicide rates by gender and age groups, and to describe patient demographics and service utilization in secondary mental health services.MethodsAll young people in contact with Child and Adolescent Mental Health Services in the year prior to death in the period 2008–2018 were identified by linking the Norwegian Cause of Death Registry and the Norwegian Patient Registry. We estimated the prevalence of contact and suicide rates among those with and without contact, by gender and age groups. Characteristics of treatment contact were compared between boys and girls. Variables with significant differences were entered into a multivariate logistic regression model using gender as an outcome.ResultsMore girls (39.7%) than boys (11.8%) had contact with Child and Adolescent Mental Health Services in the year prior to death. Among girls, suicide rates per 100,000 patients increased linearly in the age groups 10–13, 14–16, and 17–19 years: 5, 22, and 38 per 100,000 patients, respectively. Among boys, the suicide rate increased sharply from 7 per 100,000 patients in the age group 14–16 years to 40 per 100,000 patients in the 17–19-year-old group. In the age-adjusted multivariate model, boys were 4.07 (1.22–14.44, p = 0.024) times more likely to have terminated contact at the time of death.ConclusionThis study shows gender differences in both suicide rates and service utilization among young people in contact with Child and Adolescent Mental Health Services before suicide, and future studies should focus on identifying the causes of these gender differences in service contact.

Treatment Intensity in Child and Adolescent Mental Health Services and Health Care Reform in Norway, 1998–2006