Untreated Mental Illness Research Articles

Communicating About Mental Illness: What Works, What Doesn’t?

Communicating About Mental Illness: What Works, What Doesn’t?

Trainees Looking Through the Lens of a Supervisor: Remediation and Gatekeeping Responses to Hypothetical Problems of Professional Competency

ABSTRACTThis study investigated MFT trainees' perspectives of competency problems as they imagine themselves as supervisors. Trainees read seven vignettes and selected from 17 remediation responses (N = 21) originally designed for licensed supervisors (Russell, Beggs, Peterson, & Anderson, 2007). Consistent with the literature, respondents endorsed talking with the trainee as their first line of remediation and reserved dismissal for competencies related to dishonesty/fraud. Contrary to past research, trainees identified late case notes as a dismissible offense and were more lenient with untreated mental illness. Supervisors might consider orienting trainees to ethical decision making and remediation policies/strategies prior to their work in the field.

The Stigma of Mental Illness as a Barrier to Self Labeling as Having a Mental Illness.

The aim of this study was to investigate whether personal stigma decreases self-identification as having a mental illness in individuals with untreated mental health problems. We interviewed 207 persons with a currently untreated mental health problem as confirmed by a structured diagnostic interview. Measures included symptom appraisal, self-identification as having a mental illness (SELFI), self-labeling (open-ended question on the nature of their problem) stigma-related variables (explicit and implicit), as well as sociodemographics, current symptom severity, and previous treatment. Support for discrimination and implicit stigmatizing attitude were both associated with lower likelihood of self-identification. More social distance and support for discrimination were associated with less self-labeling. Previous treatment was the strongest predictor of symptom appraisal, SELFI, and self-labeling. Destigmatizing mental illness could increase awareness of personal mental health problems, potentially leading to lower rates of untreated mental illness.

Gold Award: Providing Accessible, Affordable, and Stigma-Free Behavioral Health Care for Older New Yorkers.

Gold Award: Providing Accessible, Affordable, and Stigma-Free Behavioral Health Care for Older New Yorkers.

AMA Calls on Licensing Boards to End Discrimination for MH Treatment

AMA Calls on Licensing Boards to End Discrimination for MH Treatment

Psychiatric Disease in Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive, incurable, and fatal neurodegenerative disease associated with average survival of 2 to 5 years. ALS is characterized by the progressive loss of motor neurons resulting in extremity weakness, dysarthria, dysphagia, and respiratory failure. Despite the serious nature of ALS, the mental health of patients with ALS can be relatively preserved; however, unrecognized and untreated mental illness can have a significant impact on quality of life and outcomes. Cognitive and behavioral changes can be prevalent and affect the management of patients. There are also important mental health implications for the caregiver. This article reviews the current understanding of psychiatric disease in patients with ALS. [ Psychiatr Ann . 2017;47(5):258–262. ]

Improving insomnia in primary care patients: A randomized controlled trial of nurse-led group treatment

BackgroundInsomnia is a common health problem, and most people who seek help for insomnia consult primary care. In primary care, insomnia treatment typically consists of hypnotic drugs, although cognitive behavioral therapy for insomnia is the recommended treatment. However, such treatment is currently available to few primary care patients. ObjectivesTo evaluate the effects of a group treatment program for insomnia led by nurses in primary care. Outcomeswere the Insomnia Severity Index, a 2-week sleep diary, and a questionnaire on frequency of hypnotic drug use. DesignA randomized controlled trial with pre- and post-treatment assessment and a 1-year post-treatment follow-up of the intervention group. SettingsRoutine primary health care; 7 primary care centers in Stockholm, Sweden. ParticipantsPatients consulting primary care for insomnia were assessed for eligibility. To be included, patients had to have insomnia disorder and be 18 years or older. Patients were excluded if they if they worked night shifts or had severe untreated somatic and/or mental illness, bipolar disorder, or untreated sleep disorder other than insomnia. One-hundred and sixty-five patients 20 to 90 years were included. Most were women, and many had co-existing somatic and/or mental health problems. The post-treatment dropout rate was 20%. MethodsThe intervention was a nurse-led group treatment for insomnia based on the techniques of cognitive behavioral therapy for insomnia. The nurses had 2days of training in how to deliver the program. Ninety patients were randomized to the intervention and 75 to the control group (treatment as usual). Data from 82 in the intervention and 71 in the control group were analyzed in accordance with intention-to-treat principles. Fifty-four of the 72 in the intervention group who participated in the group treatment program were followed up after 1year. ResultsMean Insomnia Severity Index score decreased significantly from 18.4 to 10.7 after group treatment but remained unchanged after treatment as usual (17.0 to 16.6). The effect size was large (1.23). Group treatment also resulted in significant improvements in all sleep diary variables (sleep onset latency, total sleep time, time awake after sleep onset, number of awakenings, and sleep quality). It also reduced hypnotic drug use. Improvements were maintained 1-year post-treatment. ConclusionsPatients with insomnia can be treated successfully with a nurse-led group treatment program in primary health care. The results support implementation of the treatment program, particularly given the need for increased access to non-pharmacological insomnia treatments.

High burden of mental illness and low utilization of care among school-going youth in Central Haiti: A window into the youth mental health treatment gap in a low-income country.

The mental health treatment gap for youth in low- and middle-income countries (LMICs) is substantial; strategies for redress are urgently needed to mitigate the serious health and social consequences of untreated mental illness in youth. To estimate the burden of major depressive episode (MDE) and posttraumatic stress disorder (PTSD) as well as utilization of care among Haitian youth in order to describe the mental health treatment gap in a LMIC setting. We estimated the point prevalence of MDE, PTSD, and subthreshold variants in a school-based sample of youth ( n = 120, ages 18-22 years) using a modified Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID)-based interview and examined treatment utilization among those receiving one of these diagnoses. We assessed additional psychopathology with self-report measures to examine validity of study diagnostic assignments. The combined prevalence of full-syndrome or subthreshold MDE or PTSD was high (36.7%). A large majority of affected individuals (88.6%) had accessed no mental health services in the health sector, and 36.4% had accessed no care of any kind in either the health or folk sectors in the past year. Findings demonstrate a high mental health burden among Haiti's youth and that many youth with MDE and PTSD are not accessing mental health care.

Outbreak of Drug-Resistant Mycobacterium tuberculosis Among Homeless People in Atlanta, Georgia, 2008-2015.

Our objective was to describe and determine the factors contributing to a recent drug-resistant tuberculosis (TB) outbreak in Georgia. We defined an outbreak case as TB diagnosed from March 2008 through December 2015 in a person residing in Georgia at the time of diagnosis and for whom (1) the genotype of the Mycobacterium tuberculosis isolate was consistent with the outbreak strain or (2) TB was diagnosed clinically without a genotyped isolate available and connections were established to another outbreak-associated patient. To determine factors contributing to transmission, we interviewed patients and reviewed health records, homeless facility overnight rosters, and local jail booking records. We also assessed infection control measures in the 6 homeless facilities involved in the outbreak. Of 110 outbreak cases in Georgia, 86 (78%) were culture confirmed and isoniazid resistant, 41 (37%) occurred in people with human immunodeficiency virus coinfection (8 of whom were receiving antiretroviral treatment at the time of TB diagnosis), and 10 (9%) resulted in TB-related deaths. All but 8 outbreak-associated patients had stayed overnight or volunteered extensively in a homeless facility; all these facilities lacked infection control measures. At least 9 and up to 36 TB cases outside Georgia could be linked to this outbreak. This article highlights the ongoing potential for long-lasting and far-reaching TB outbreaks, particularly among populations with untreated human immunodeficiency virus infection, mental illness, substance abuse, and homelessness. To prevent and control TB outbreaks, health departments should work with overnight homeless facilities to implement infection control measures and maintain searchable overnight rosters.

Making space for restoration: epistemological pluralism within mental health interventions in Kinshasa, Democratic Republic of Congo

Global health policymakers have recently begun to focus their attention on high levels of untreated mental illness in low‐ and middle‐income countries. They have, in turn, initiated a series of interventions intended to reduce the global ‘treatment gap’ that has emerged between those requiring treatment and those able to access it. Yet critics have challenged the questionable epistemological assumptions embedded in these interventions and have decried the lack of attention given to the translation and implementation of such projects in resource‐limited contexts. In this paper, I focus on ongoing attempts to diminish the mental health treatment gap in Kinshasa, Democratic Republic of Congo to illuminate how dominant thinking about ameliorating the global treatment gap remains rooted in a reductive biomedical paradigm. Drawing on interviews conducted with 16 psychiatrists in the city, I show how a series of epistemological assumptions about treatment have affected the success of treatment delivery in two donor‐funded interventions. I then contrast the dominant biomedical approach with the perspectives of three younger voices in the city's psychiatric community. I reveal how an alternative epistemological framework, similar to that of the phenomenological tradition, informs their own successful treatment expansion efforts. This alternative perspective, I propose, challenges practitioners and geographers alike to cultivate new ways of approaching global mental health that acknowledge the value of patient experiences and make possible more responsive forms of treatment and care.

Current Challenges and Future Opportunities for Child and Adolescent Psychiatry in Japan.

Japan has been facing a serious shortfall of child and adolescent psychiatric workforce relative to increasing service needs. Likely because of a combination of limited workforce supply and limited trust or perception of effectiveness, mental health services are under-utilized by the educational and child welfare systems. Child and adolescent psychiatry (CAP) has not been a formally established specialty in Japan. The lack of basic structure in the specialty most likely contributes to a lack of training facilities, limited exposure to and interest in the specialty, and hence an inadequate workforce. To date, there exists no standardized training program for CAP in Japan and each training hospital determines its own teaching curriculum and training content. Clinical experience in CAP varies greatly among hospitals. To solve current problems in child and adolescent psychiatry in Japan, we advocate for the development and establishment of a more standardized child and adolescent psychiatry training system that is akin to what exists in the US and that teaches and evaluates according to specific competencies. Through standardizing care and education and ultimately improving workforce, the quality of mental health services can be raised. The tragic and costly consequences of unidentified and untreated mental illness in youth can be avoided by taking timely evidence based actions in partnership with others.

Why family physicians are the best people to stop the tragedy of untreated mental illness in India

Why family physicians are the best people to stop the tragedy of untreated mental illness in India

APA Registry May Advance Early Detection of Psychosis

Back to table of contents Previous article Next article Professional NewsFull AccessAPA Registry May Advance Early Detection of PsychosisMark MoranMark MoranSearch for more papers by this authorPublished Online:14 Nov 2016https://doi.org/10.1176/appi.pn.2016.11b9AbstractAPA’s patient registry, if it includes integrated care systems that are also linked to local educational systems, may be useful for identifying children and adolescents who display signs of prodromal psychosis.A national mental health registry—such as the one under development by APA to help psychiatrists meet quality reporting and Maintenance of Certification (MOC) requirements—may also help to reduce duration of untreated psychosis by enhancing early detection, referral of patients, tracking of symptoms over time, and treatment effects at the psychiatrist, clinic, and national levels.“In order to achieve this goal, a registry needs to include psychiatrists involved in integrated care arrangements with primary care, and especially the inclusion of health systems that are integrated with educational systems,” said APA Deputy Director of Research Diana E. Clarke, Ph.D., M.Sc. “It may also require interoperability between mental health and primary care registries and be open to modifications as knowledge improves.” Clarke spoke last month at APA’s fall meeting, IPS: The Mental Health Services Conference, in Washington, D.C. (During the symposium, panelist Carol Tamminga, M.D., was presented with APA’s Research Award. See box.)Throughout the symposium—and during other lectures and symposia at the IPS—clinicians and researchers emphasized the importance of early detection of psychosis and, especially, the need to shorten the duration of untreated psychosis (DUP) to improve the long-term trajectory of illness. The patient registry being developed by APA may prove to be a critical tool in these efforts. “Nationally, the registry can allow participating clinicians to track their patients’ symptom profiles and changes in severity over time and easily identify individuals at risk for psychosis by providing measures that indicate presence of psychotic symptoms and biomarkers, such as any lag in neurocognitive development,” Clarke said. “It can also help clinicians monitor prescriptions and medication use. Ideally, the registry can help clinicians engage patients and families in the treatment process.”APA President-elect Anita Everett, M.D, who was the discussant at the symposium, agreed. “There is growing strength in the evidence that if we can identify high-risk cases early and provide psychosocial support and treatment, we can shorten the duration of untreated mental illness and psychosis, keep a person on track, and ultimately change the trajectory of a person’s life who otherwise might track into a long-term disabling condition such as schizophrenia and severe bipolar disorder,” she said in comments to Psychiatric News following the meeting. “Multiple components are coming together that now support this. These include increasing knowledge about our brain’s plasticity or ability to change biochemically and structurally coupled with the demonstrated value of coordinated specialty care that includes specific interventions such as education coaching, psychotherapy, and pharmacotherapy. APA began exploring the possibility of creating a patient registry in 2014, and last year the Board of Trustees formally approved a pilot project. In the discussion leading up to that vote, Gregory Dallack, M.D., chair of the APA Registry Work Group, told trustees the registry could help improve health outcomes for patients served by APA members, identify effective patterns of care and best practices on a national basis. A registry can assist members with meeting quality-reporting requirements for Medicare and MOC requirements, he said.At the IPS symposium, Clarke emphasized the importance of including in the registry integrated care networks that are also integrated with local educational systems, where teachers and school administrators can identify children and adolescents in need of mental health treatment. Integrated care practice administrators can then register individuals with early symptoms of psychosis and trigger a referral for care when appropriate. “The registry manager can identify, on an aggregate level, sites with groups of patients with symptoms of psychosis, especially those with no indicated follow-up care,” Clarke said. “And the registry manager can also identify treatments that work or don’t work.” ■More information about the APA registry can be accessed here or available from Philip Wang, M.D., Dr.P.H., at [email protected]. ISSUES NewArchived

An organisational change intervention for increasing the delivery of smoking cessation support in addiction treatment centres: study protocol for a randomized controlled trial

BackgroundThe provision of smoking cessation support in Australian drug and alcohol treatment services is sub-optimal. This study examines the cost-effectiveness of an organisational change intervention to reduce smoking amongst clients attending drug and alcohol treatment services.Methods/designA cluster-randomised controlled trial will be conducted with drug and alcohol treatment centres as the unit of randomisation. Biochemically verified (carbon monoxide by breath analysis) client 7-day-point prevalence of smoking cessation at 6 weeks will be the primary outcome measure. The study will be conducted in 33 drug and alcohol treatment services in four mainland states and territories of Australia: New South Wales, Australian Capital Territory, Queensland, and South Australia. Eligible services are those with ongoing client contact and that include pharmacotherapy services, withdrawal management services, residential rehabilitation, counselling services, and case management services. Eligible clients are those aged over 16 years who are attending their first of a number of expected visits, are self-reported current smokers, proficient in the English language, and do not have severe untreated mental illness as identified by the service staff. Control services will continue to provide usual care to the clients. Intervention group services will receive an organisational change intervention, including assistance in developing smoke-free policies, nomination of champions, staff training and educational client and service resources, and free nicotine replacement therapy in order to integrate smoking cessation support as part of usual client care.DiscussionIf effective, the organisational change intervention has clear potential for implementation as part of the standard care in drug and alcohol treatment centres.Trial registrationAustralian and New Zealand Clinical Trials Registry, ACTRN12615000204549. Registered on 3 March 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1401-6) contains supplementary material, which is available to authorized users.

Majority of Americans Say Mental Illness Impacts Overall Health, Economy, But Congress Not Acting on Issues

Back to table of contents Previous article Next article Government NewsFull AccessMajority of Americans Say Mental Illness Impacts Overall Health, Economy, But Congress Not Acting on IssuesMark MoranMark MoranSearch for more papers by this authorPublished Online:26 May 2016https://doi.org/10.1176/appi.pn.2016.6a10AbstractWhile those polled said that comprehensive mental health reform is important in addressing societal challenges, only 5 percent of Americans believe Congress has made mental health care a priority.Roughly two-thirds of Americans believe that untreated mental illness has a significant impact on the U.S. economy and that comprehensive mental health reform is important in addressing societal challenges, such as high suicide rates and access to care. At the same time, only 5 percent of Americans believe Congress has made mental health a priority. Which presidential candidate do you feel will be best to ensure that the needs of those living with mental health issues are met?The findings are from an APA-sponsored poll conducted by Porter Novelli and the GfK Knowledge Panel, a market research firm, and were announced last month at APA’s 2016 Annual Meeting.Candidates seeking the White House didn’t score high marks either when Americans were asked which candidate would best ensure that the needs of those living with mental health problems are met. Democrat Hillary Clinton came in first at 21 percent, with Vermont Sen. Bernie Sanders a close second at 19 percent. About 10 percent said Republican Donald Trump would be the best in meeting the nation’s mental health needs.APA has endorsed efforts in Congress to reform the nation’s mental health system, voicing its support for the Helping Families in Mental Health Crisis Act, introduced by Reps. Tim Murphy (R-Pa.) and Eddie Bernice Johnson (D-Texas), and the Mental Health Reform Act of 2015, introduced by Sens. Chris Murphy (D-Conn.) and Bill Cassidy (R-La.). Legislation in both the House and the Senate has stalled this year. “We applaud the lawmakers in Congress who recognize the dire need to improve our nation’s mental health system,” said APA President Renȳe Binder, M.D. “But we call upon Congress as a whole to embrace this issue. Our poll findings show that the majority of Americans want to see improved mental health care and access.”“The fact that a vast majority of Americans, 80 percent, agree that someone’s mental health has an impact on their physical health just shows the need for us to improve the nation’s mental health system,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “It also illustrates the importance of collaborative care between psychiatry and other medical specialties. APA will continue its hard work to make both goals, mental health reform and collaborative care, a reality.”The poll also found that public perceptions of mental health are improving but still have a way to go. About 45 percent of respondents agree that there is less stigma against mental illness than there was a decade ago; however, 31 percent say they would not vote for a political candidate who was diagnosed with a mental illness, even if the candidate had been treated for it.Other key findings of the poll:Only 15 percent of respondents agree that the mental health needs of military veterans are being met in the current mental health system.80 percent of respondents agree that a person’s mental health has an impact on his or her physical health.Nearly 20 percent of respondents have personally sought care from a mental health professional, and 29 percent know a family member who has.Nearly 50 percent of respondents say they either do not know or are not sure how to access mental health care for themselves or a loved one.“It is encouraging to see the progress in reduced stigma of mental illness over time, but the poll clearly shows that we have a long way to go before the majority of Americans view mental illness the same as physical illness,” Binder said. “Mental illness is no different than physical illness. There is help available, and treatment works.” ■ ISSUES NewArchived

Ethical and Clinical Dilemmas in Using Psychotropic Medications During Pregnancy.

Approximately 15 percent of women experience depression while pregnant or in the year following pregnancy. While antidepressants are usually effective and considered standard treatment for depression, concerns arise that what might be good for mom could be harmful for the baby. Medical evidence demonstrates that, on balance, treating mental illness with psychotropic medication along with talk therapy is in the best interest of both mother and baby; however, women may resist treatment because they overestimate the risks of medication and underestimate the risks of untreated mental illness. Clinicians can help address this perceived ethical dilemma and provide optimum care to their pregnant patients by collaborating with their patients on a treatment plan, informing them about the risks of untreated mental illness, and providing reassurance that selective serotonin reuptake inhibitors (SSRIs) and many other psychotropic medications are appropriate care even if a woman is pregnant or breastfeeding.

The stigma of mental illness in children and adolescents: A systematic review

IntroductionOne in ten children and adolescents experience mental health difficulties at any given time, yet only one third of those suffering access treatment. Untreated mental illness predisposes to longstanding individual difficulties, and presents a great public health burden. Large scale initiatives to reduce stigmatization of mental illness in children and adolescents, identified as a key deterrent to treatment, have had limited success, and research is scarce.AimsTo gain a better understanding of the stigma experienced by children and adolescents with mental health difficulties.ObjectivesWe conducted a systematic review of the literature examining stigma and self-stigma towards children and adolescents with mental health difficulties, in order to better understand the extent and type of discrimination directed towards this particularly vulnerable group.MethodsFollowing PRISMA guidelines, the databases Pubmed, PsychINFO and Cochrane were searched for original research published between 1980 and 2014, assessing public stigma (i.e. the reaction of the general public) and self-stigma (i.e. internalized public stigma) towards children and adolescents with mental health difficulties.ResultsThirty-seven studies were identified, confirming that stigmatization towards children and young people suffering mental health difficulties is a universal and disabling problem. There was some variation by diagnosis and gender, and stigmatization was for the most part unaffected by labelling. Self-stigmatization led to more secrecy and avoidance of interventions.ConclusionsThe findings confirm that stigmatization of mental illness is poorly understood due to a lack of evidence and methodological discrepancies. Implications of the findings are discussed, and suggestions made for future research.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Child abuse: the role of psychiatrists

Child maltreatment is increasingly being recognised as an important public health issue in Sri Lanka. Psychiatrists in Sri Lanka have a central role to play in aspects of prevention, recognition, assessment and management of child maltreatment. Child abuse can be defined as acts of omission or commission in interactions between adults or adolescents and children that have caused, or are likely to cause, injury, death or emotional harm to the child (1). They include neglect, physical abuse, emotional abuse, sexual abuse and fabricated or induced illness. It is believed that more than 40 million children worldwide are abused each year (1). Prevalence of child abuse has been recorded to be as high as 53% while sexual abuse rates ranged from 23.5 to 27.5% in females (2). Studies show child abuse occurs within all cultures, ethnicities and religions, at every socioeconomic and educational level. Available data in Sri Lanka, though lacking, suggests the annual incidence of sexual abuse to be more than 6000 and that 40.7% of parents have physically abused their children in the previous month (3). Significant media attention to matters relating to child abuse and neglect over the last few months have given the impression that child abuse and neglect have recently increased in Sri Lanka. While true increase in the incidence cannot be ascertained, potential causative factors such as mothers leaving for overseas employment, internal migration of parents due to economic reasons and lack of support from extended family have become common in the country. Sri Lankans’ increasing preoccupation of success and achievement in both adults and children have reduced the quality of child-parent relationship, making children more vulnerable. Poor parenting skills, serious marital issues, domestic violence, paternal alcohol misuse, poverty, lack of education, social isolation, untreated mental illness in parents and acceptance of the use of violence and force in disciplining children have been identified as causes for child maltreatment which are not uncommon in Sri

"How I Floated on Gentle Webs of Being": Psychiatrists Stories About the Mental Health Treatment Gap in Africa.

A strong movement has emerged recently which is highlighting the high levels of untreated mental illness in Africa and making proposals for reducing this 'gap' in mental health care. This movement has been criticised for insufficiently attending to the epistemologies embedded in its recommendations, and inadequately considering the views of practitioners 'on the ground'. Employing a narrative-based approach, I accessed the stories about the mental health 'treatment gap' of 28 psychiatrists all working clinically in public mental health care settings in South Africa, Uganda, Nigeria or Ethiopia. Rather than focusing on the content of these stories, I was more interested in their underpinning meaning-codes and epistemological politics. Dominant thinking about the 'treatment gap' was heavily informed by a biomedical paradigm, and associated epistemological order of European Colonial Modernity. There were, however, cracks in this master narrative, which crystalised in the stories that were told by three particular psychiatrists. Their narratives operated within an alternative paradigm, one which appears to be informed by the tradition of phenomenology, and in particular the ideas associated with French philosopher Merleau-Ponty. This more marginalised thinking may offer important insights into reducing the mental health 'treatment gap' in Africa in ways very different from those created by current seats of power.

The role of youth mental health services in the treatment of young people with serious mental illness: 2-year outcomes and economic implications.

This study aims to evaluate the outcomes and economic case for a UK innovative youth-specific mental health service for 16-25 year olds. A pre-, during- and post-treatment comparative design for 20 young people at high risk of developing psychosis who received 2 years' treatment with the service, using outcomes that concurred with the service aims: changes in mental health, employment rates and service use. Forty-five percent of those at risk and with symptoms of serious mental illness commencing treatment were not receiving mental health services at baseline. Compared with service use prior to treatment at the youth-specific service, hospital admissions, Accident and Emergency, and criminal justice system use appear to decrease over the 2 years of treatment and the year after treatment, with potential cost differences of £473 000. Mental health improved or stayed the same, compared with baseline. Employment rates improved, although the sample size for this is very small. Potential cost differences associated with service users moving into employment over the 2 years are £148 000. The estimated cost over 2 years of providing the youth-specific mental health service to these young people was £106 000. Given the extensive long-term negative consequences and high costs of untreated mental illness in the 16-25 age group and the documented problems young people have in receiving appropriate services, this youth-specific, age-appropriate service model appears to be successful, with improved outcomes and cost differences in the short-term, and with encouraging implications for the longer term.