Primary Youth Mental Health Services Research Articles

Eco-anxiety among regional Australian youth with mental health problems: A qualitative study.

In Australia, climate-related disasters disproportionately affect rural, regional and remote young people with effects ranging from severe flooding and catastrophic fires to unbearable heat and yet most studies on eco-anxiety are based on reports by urban youth who do not have direct experiences of such impacts. Furthermore, there is a dearth of research on how eco-anxiety impacts those who already experience mental health problems. The present study aims to address this gap by focussing on the lived experiences of regional Australian youth with recent experience of climate-related disasters alongside clinical insights from those involved in their care. Two groups, a clinician and client group, were recruited through headspace Port Macquarie-a primary youth mental health service in a regional city of New South Wales, Australia. In all, 25 participants took part in focus group discussions, including 13 clinicians and 12 clients of the service. Clients and clinicians responded to a version of the same questions: (1) whether the effects of climate change impact on regional youth with mental health problems, (2) how young people cope with eco-anxiety and (3) how regional communities can help young people cope with eco-anxiety better. Group discussions were audio-recorded and transcribed. Transcripts were analysed according to the principles of Interpretative Phenomenological Analysis using a team approach. Three dimensions of eco-anxiety were identified by clinicians and clients-helplessness in the present, hopelessness about the future and acute stress and anxiety related to experiences of severe flooding and fires. Clinicians and clients also thought that a misalignment between young people and older generations, including government, was a source of eco-anxiety and having a collective voice was seen as important for regional youth as was community support through social media sites. Clinicians thought that eco-anxiety was 'in the background' for their clients, whereas the clients who participated were clearly experiencing eco-anxiety. Whereas clinicians could identify potential coping strategies, clients could not. Eco-anxiety can be experienced by regional youth with mental health problems as both an acute response to natural hazards and a more sustained sense of hopelessness about the future. Impacts of acute anxiety and chronic hopelessness, with its associated depression risk, among young people with pre-existing mental health problems warrants further investigation as this study suggests that it may exacerbate their existing conditions. Clinicians and clients in this region would benefit from specific training and resources related to the identification and treatment of eco-anxiety. Future research on climate-related mental health should be inclusive of the perspectives of those who have direct experience of climate-related adverse events.

Patterns of emergency department presentations for a youth mental health cohort: data-linkage cohort study.

Primary youth mental health services in Australia have increased access to care for young people, yet the longer-term outcomes and utilisation of other health services among these populations is unclear. To describe the emergency department presentation patterns of a help-seeking youth mental health cohort. Data linkage was performed to extract Emergency Department Data Collection registry data (i.e. emergency department presentations, pattern of re-presentations) for a transdiagnostic cohort of 7024 youths (aged 12-30 years) who presented to mental health services. Outcome measures were pattern of presentations and reason for presentations (i.e. mental illness; suicidal behaviours and self-harm; alcohol and substance use; accident and injury; physical illness; and other). During the follow-up period, 5372 (76.5%) had at least one emergency department presentation. The presentation rate was lower for males (IRR = 0.87, 95% CI 0.86-0.89) and highest among those aged 18 to 24 (IRR = 1.117, 95% CI 1.086-1.148). Almost one-third (31.12%) had an emergency department presentation that was directly associated with mental illness or substance use, and the most common reasons for presentation were for physical illness and accident or injury. Index visits for mental illness or substance use were associated with a higher rate of re-presentation. Most young people presenting to primary mental health services also utilised emergency services. The preventable and repeated nature of many presentations suggests that reducing the ongoing secondary risks of mental disorders (i.e. substance misuse, suicidality, physical illness) could substantially improve the mental and physical health outcomes of young people.

A multidimensional approach for differentiating the clinical needs of young people presenting for primary mental health care

ObjectivesThere is an ongoing necessity to match clinical interventions with the multidimensional needs of young people. A key step toward better service planning and the design of optimal models of care is to use multidimensional assessment to understand the clinical needs of those presenting to primary mental health care. Methods1284 people aged 12–25 years presenting to primary youth mental health services completed an online assessment at service entry. Latent class analysis was conducted for seven scales assessing anxiety, depression, psychosis, mania, functioning (indexed by Work and Social Adjustment Scale), and suicidality. ResultsA three-class solution was identified as the optimal solution. Class 1 (n = 305, 23.75%), an early illness stage group, had low and mixed symptomatology with limited functional impairment, class 2 (n = 353, 27.49%) was made up of older persons with established depression and functional impairment, and class 3 (n = 626, 48.75%) had very high and complex needs, with functional impairment, suicidality, and at-risk mental states (psychosis or mania). Additional differentiating characteristics included psychological distress, circadian disturbances, social support, mental health history, eating disorder behaviours, and symptoms of post-traumatic stress disorder. ConclusionsA large proportion of help-seeking young people present with symptoms and functional impairment that may exceed the levels of care available from basic primary care or brief intervention services. These subgroups highlight the importance of multidimensional assessments to determine appropriate service pathways and care options.

Recommendations for Designing Health Information Technologies for Mental Health Drawn From Self-Determination Theory and Co-design With Culturally Diverse Populations: Template Analysis.

BackgroundCulturally diverse populations (including Aboriginal and Torres Strait Islander people, people of diverse genders and sexualities, and culturally and linguistically diverse people) in nonurban areas face compounded barriers to accessing mental health care. Health information technologies (HITs) show promising potential to overcome these barriers.ObjectiveThis study aims to identify how best to improve a mental health and well-being HIT for culturally diverse Australians in nonurban areas.MethodsWe conducted 10 co-design workshops (N=105 participants) in primary youth mental health services across predominantly nonurban areas of Australia and conducted template analysis on the workshop outputs. Owing to local (including service) demographics, the workshop participants naturalistically reflected culturally diverse groups.ResultsWe identified 4 main themes: control, usability, affirmation, and health service delivery factors. The first 3 themes overlap with the 3 basic needs postulated by self-determination theory (autonomy, competence, and relatedness) and describe participant recommendations on how to design an HIT. The final theme includes barriers to adopting HITs for mental health care and how HITs can be used to support care coordination and delivery. Hence, it describes participant recommendations on how to use an HIT.ConclusionsAlthough culturally diverse groups have specific concerns, their expressed needs fall broadly within the relatively universal design principles identified in this study. The findings of this study provide further support for applying self-determination theory to the design of HITs and reflect the tension in designing technologies for complex problems that overlap multiple medical, regulatory, and social domains, such as mental health care. Finally, we synthesize the identified themes into general recommendations for designing HITs for mental health and provide concrete examples of design features recommended by participants.

Optimising the integration of technology-enabled solutions to enhance primary mental health care: a service mapping study

BackgroundDespite the widely acknowledged potential for health information technologies to improve the accessibility, quality and clinical safety of mental health care, implementation of such technologies in services is frequently unsuccessful due to varying consumer, health professional, and service-level factors. The objective of this co-design study was to use process mapping (i.e. service mapping) to illustrate the current consumer journey through primary mental health services, identify barriers to and facilitators of quality mental health care, and highlight potential points at which to integrate the technology-enabled solution to optimise the provision of care based on key service performance indicators.MethodsInteractive, discussion-based workshops of up to six hours were conducted with representative stakeholders from each participating service, including health professionals, service managers and administrators from Open Arms – Veterans & Families Counselling Service (Sydney), a counselling service for veterans and their families, and five headspace centres in the North Coast Primary Health Network, primary youth mental health services. Service maps were drafted and refined in real time during the workshops. Through both group discussion and the use of post-it notes, participants worked together to evaluate performance indicators (e.g. safety) at each point in the consumer journey (e.g. intake) to indicate points of impact for the technology-enabled solution, reviewing and evaluating differing opinions in order to reach consensus.ResultsParticipants (n=84 across participating services) created service maps illustrating the current consumer journey through the respective services and highlighting barriers to and facilitators of quality mental health care. By consensus, the technology-enabled solution as facilitated by the InnoWell Platform was noted to enable the early identification of risk, reduce or eliminate lengthy intake processes, enable routine outcome monitoring to revise treatment plans in relation to consumer response, and serve as a personal data record for consumers, driving person-centred, coordinated care.ConclusionsService mapping was shown to be an effective methodology to understand the consumer’s journey through a service and served to highlight how the co-designed technology-enabled solution can optimise service pathways to improve the accessibility, quality and clinical safety of care relative to key service performance indicators, facilitating the delivery of the right care.

Flip the Clinic: A Digital Health Approach to Youth Mental Health Service Delivery During the COVID-19 Pandemic and Beyond.

The demand for mental health services is projected to rapidly increase as a direct and indirect result of the COVID-19 pandemic. Given that young people are disproportionately disadvantaged by mental illness and will face further challenges related to the COVID-19 pandemic, it is crucial to deliver appropriate mental health care to young people as early as possible. Integrating digital health solutions into mental health service delivery pathways has the potential to greatly increase efficiencies, enabling the provision of “right care, first time.” We propose an innovative digital health solution for demand management intended for use by primary youth mental health services, comprised of (1) a youth mental health model of care (ie, the Brain and Mind Centre Youth Model) and (2) a health information technology specifically designed to deliver this model of care (eg, the InnoWell Platform). We also propose an operational protocol of how this solution could be applied to primary youth mental health service delivery processes. By “flipping” the conventional service delivery models of majority in-clinic and minority web-delivered care to a model where web-delivered care is the default, this digital health solution offers a scalable way of delivering quality youth mental health care both in response to public health crises (such as the COVID-19 pandemic) and on an ongoing basis in the future.

Technology-Enabled Solutions for Australian Mental Health Services Reform: Impact Evaluation.

BackgroundHealth information technologies (HITs) are becoming increasingly recognized for their potential to provide innovative solutions to improve the delivery of mental health services and drive system reforms for better outcomes.ObjectiveThis paper describes the baseline results of a study designed to systematically monitor and evaluate the impact of implementing an HIT, namely the InnoWell Platform, into Australian mental health services to facilitate the iterative refinement of the HIT and the service model in which it is embedded to meet the needs of consumers and their supportive others as well as health professionals and service providers.MethodsData were collected via web-based surveys, semistructured interviews, and a workshop with staff from the mental health services implementing the InnoWell Platform to systematically monitor and evaluate its impact. Descriptive statistics, Fisher exact tests, and a reliability analysis were used to characterize the findings from the web-based surveys, including variability in the results between the services. Semistructured interviews were coded using a thematic analysis, and workshop data were coded using a basic content analysis.ResultsBaseline data were collected from the staff of 3 primary youth mental health services (n=18), a counseling service for veterans and their families (n=23), and a helpline for consumers affected by eating disorders and negative body image issues (n=6). As reported via web-based surveys, staff members across the services consistently agreed or strongly agreed that there was benefit associated with using technology as part of their work (38/47, 81%) and that the InnoWell Platform had the potential to improve outcomes for consumers (27/45, 60%); however, there was less certainty as to whether their consumers’ capability to use technology aligned with how the InnoWell Platform would be used as part of their mental health care (11/45, 24% of the participants strongly disagreed or disagreed; 15/45, 33% were neutral; and 19/45, 42% strongly agreed or agreed). During the semistructured interviews (n=3) and workshop, participants consistently indicated that the InnoWell Platform was appropriate for their respective services; however, they questioned whether the services’ respective consumers had the digital literacy required to use the technology. Additional potential barriers to implementation included health professionals’ digital literacy and service readiness for change.ConclusionsDespite agreement among participants that HITs have the potential to result in improved outcomes for consumers and services, service readiness for change (eg, existing technology infrastructure and the digital literacy of staff and consumers) was noted to potentially impact the success of implementation, with less than half (20/45, 44%) of the participants indicating that their service was ready to implement new technologies to enhance mental health care. Furthermore, participants reported mixed opinions as to whether it was their responsibility to recommend technology as part of standard care.