Service responses for youth onset mental disorders

Centre for Adolescent Health, Murdoch Childrens Research Institute, Royal Children's Hospital, University of Melbourne, Australia.
Current Opinion in Psychiatry (Impact Factor: 3.94). 08/2007; 20(4):319-24. DOI: 10.1097/YCO.0b013e3281eb906d
Source: PubMed


Many psychiatric disorders have their highest first-onset rates in adolescence and young adulthood. We summarize recent work indicating where interventions are most needed and effective. We also review the literature that examines the scope for reorienting mental health services to meet the needs of adolescents and young adults.
The continuities between youth onset and later life disorders, as well as later social adjustment, have become clearer. Emotional disorders that persist or recur during the teens have the greatest effect on future mental health. To date, service systems, even in the developed world, cater poorly for youth with mental disorders. Intervention studies demonstrate the short-term benefits of intensive multidisciplinary intervention for early psychosis. There are few data concerning the benefit of early intervention for other disorders. Long-term benefits for early intervention for any condition are unknown. Youth streams of psychiatric care have developed for early-onset psychotic disorders.
An increasing understanding of the high prevalence and longer-term effects of youth onset mental disorders has not yet been adequately matched by intervention research or the evaluation of different models of mental health service delivery.

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    • "The only selection criterion we used was for participants to be receiving a service from the agency. Participants were largely between 16 and 35 years of age, as this was a typical inclusion criterion for early intervention in psychosis services (Patton et al. 2007), but the sample was not restricted by age or diagnosis. In the social inclusion projects (agencies A and E), we also included people with other mental health problems, and those above the age of 35, to obtain their experience of innovative practice that may not have been captured elsewhere in the study. "
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    ABSTRACT: People with severe mental health problems such as psychosis have access to less social capital, defined as resources within social networks, than members of the general population. However, a lack of theoretically and empirically informed models hampers the development of social interventions which seek to enhance an individual's social networks. This paper reports the findings of a qualitative study, which used ethnographic field methods in six sites in England to investigate how workers helped people recovering from psychosis to enhance their social networks. This study drew upon practice wisdom and lived experience to provide data for intervention modelling. Data were collected from 73 practitioners and 51 people who used their services in two phases. Data were selected and coded using a grounded theory approach to depict the key themes that appeared to underpin the generation of social capital within networks. Findings are presented in four over-arching themes – worker skills, attitudes and roles; connecting people processes; role of the agency; and barriers to network development. The sub-themes which were identified included worker attitudes; person-centred approach; equality of worker–individual relationship; goal setting; creating new networks and relationships; engagement through activities; practical support; existing relationships; the individual taking responsibility; identifying and overcoming barriers; and moving on. Themes were consistent with recovery models used within mental health services and will provide the basis for the development of an intervention model to enhance individuals’ access to social capital within networks.
    Health & Social Care in the Community 11/2014; 23(2). DOI:10.1111/hsc.12135 · 1.15 Impact Factor
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    • "Beneficial 12-and 18-month outcomes were found for the specialist intervention in global functioning, hospitalization rates, and vocational and social parameters (Garety et al. 2006). However, controlling for differences in baseline parameters such as previous psychotic episodes and ethnicity obviated the advantage in terms of relapse rates (Patton et al. 2007). At 5 years follow-up any benefit in terms of reduced hospital use had disappeared (Gafoor et al. 2008). "
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    ABSTRACT: This paper reviews the literature on early intervention in psychotic disorders, weighs the cons of this approach, and makes suggestions for clinicians and researchers regarding how to interpret and respond to what is still an embryonic evidence-base, notably in terms of any long-term benefits.
    Psychological Medicine 03/2010; 40(3):353-8. DOI:10.1017/S0033291709990341 · 5.94 Impact Factor
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    • "Although is not yet possible to draw a definitive conclusion about its effectiveness, EIP is considered " an opportunity to make major positive changes in psychiatric practice " (Marshall & Rathbone, 2006). EIP remains a stimulating multidisciplinary approach to psychosis and a demanding commitment, not only for mental health professionals but also for service developers (Patton et al., 2007; Killackey et al., 2006). Population studies have estimated that approximately one-third of patients suffering from schizophrenia never seek help or treatment (Thornicroft, 2008; Larsen et al., 2001). "
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    ABSTRACT: Psychosis is a traumatic experience for both sufferers and their families. The morbidity and mortality associated with psychosis may be improved by an assertive, specialised, multidisciplinary approach to care, provided at the earliest opportunity. Early Intervention in Psychosis (EIP) uses such approach to improve the individual's short and long-term symptomatic and functional outcome, as well as quality of life. However, there is still controversy about whether this type of intervention is effective enough to justify its associated costs. We reviewed evidence from the literature on EIP for schizophrenia spectrum and non-affective psychoses, with particular attention to evidence on its effectiveness in reducing the duration of untreated symptoms, preventing relapses and reducing admission rates, reducing suicide rates, and reducing treatment costs. There is preliminary evidence that EIP may be effective in delaying transition to psychosis, reducing DUP, preventing relapses, reducing admission and suicidal rates, and reducing treatment costs. EIP remains a stimulating multidisciplinary approach to psychosis and a demanding commitment for mental health professionals and service developers.
    Epidemiologia e psichiatria sociale 09/2008; 17(3):227-35. DOI:10.1017/S1121189X00001329 · 3.16 Impact Factor
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