Prevention, innovation and implementation science in mental health: The next wave of reform

The British Journal of Psychiatry (Impact Factor: 7.99). 01/2013; 202(s54):s3-s4. DOI: 10.1192/bjp.bp.112.119222


Although the corrosive effect of mental ill health on human health and happiness has long been recognised, it is only relatively recently that mental illness has been acknowledged as one of the major threats to economic productivity worldwide. This is because the major mental disorders most commonly have their onset during adolescence and early adulthood, and therefore have a disproportionate impact on the most productive decades of life. With the costs associated with mental ill health estimated to double over the next two decades, a greater emphasis on prevention and early intervention has become even more imperative. Although prevention largely remains aspirational for many reasons, early intervention is well within our current reach and offers the potential to significantly reduce the impact of mental ill health on our health, happiness and prosperity in the immediate future.

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    • "Adolescents with mental disorders face greater challenges as they transition to adulthood than their peers with or without other disabilities; overall, rates of mental health problems increase during adolescence, problems become more complex, and serious disorders, such as psychosis, emerge [99] [22] [109] [50] [53]. Most adolescent disorders are often undifferentiated , with polysymptomatic presentations, that, later in life, progress to more traditional, differentiated types [59] [68]. Emerging knowledge about psychopathology and brain development in adolescence is, both, of great relevance and crucial to improving and guiding prevention and public health engagement. "
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    ABSTRACT: Background: Data are progressively accumulating regarding the transition to adult services. Methods: A comprehensive search using the MEDLINE, Embase, PsycINFO, and Cochrane databases up until 16 March 2015 was conducted in order to summarize recent evidence on the transition from child to adult mental health services for patients with mental disorders. Authors extracted data and assessed study quality independently. Results: The main findings of the 33 included studies were discussed taking into consideration four aspects: experiences of patients, carers, and clinicians, accounts of transition, current services models and protocols, and outcomes of transition. Of the 33 studies, 17 focused on a specific mental disorder: seven on attention deficit hyperactivity disorder, four on intellectual disability, three on eating disorders, two on serious emotional disorders and one on autism spectrum disorder. An attempt was also made to integrate the studies' conclusions in order to improve transitional care. Conclusions: The review reveals an evident need for longitudinal, controlled, health services research to identify and evaluate optimal service models with systematic and seamless transition protocols for patients with mental disorders requiring continuity of care into adult mental services.
    No preview · Article · Nov 2015 · European Psychiatry
    • "It is not our intention to foster stigma or damage the prospects of NEET youth by adding the stereotype of 'mentally ill' to the stereotype of 'unmotivated .' Instead, our view is that treating their mental health problems early may be an intervention target with long-term dividends for the children themselves as well as society (McGorry, 2013). Recent reports suggest that most British adolescents visit their GPs several times per year, which could provide opportunities to query mental health and substance abuse issues in primary care settings (Hagell, Coleman, & Brooks, 2013). "
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    ABSTRACT: Background Labour market disengagement among youths has lasting negative economic and social consequences, yet is poorly understood. We compared four types of work-related self-perceptions, as well as vulnerability to mental health and substance abuse problems, among youths not in education, employment or training (NEET) and among their peers.Methods Participants were from the Environmental Risk (E-Risk) longitudinal study, a nationally representative UK cohort of 2,232 twins born in 1994–1995. We measured commitment to work, job-search effort, professional/technical skills, ‘soft’ skills (e.g. teamwork, decision-making, communication), optimism about getting ahead, and mental health and substance use disorders at age 18. We also examined childhood mental health.ResultsAt age 18, 11.6% of participants were NEET. NEET participants reported themselves as committed to work and searching for jobs with greater diligence than their non-NEET peers. However, they reported fewer ‘soft’ skills (B = −0.98, p < .001) and felt less optimistic about their likelihood of getting ahead in life (B = −2.41, p < .001). NEET youths also had higher rates of concurrent mental health and substance abuse problems, but these did not explain the relationship with work-related self-perceptions. Nearly 60% of NEET (vs. 35% of non-NEET) youths had already experienced ≥1 mental health problem in childhood/adolescence. Associations of NEET status with concurrent mental health problems were independent of pre-existing mental health vulnerability.Conclusions Our findings indicate that while NEET is clearly an economic and mental health issue, it does not appear to be a motivation issue. Alongside skills, work-related self-perceptions and mental health problems may be targets for intervention and service provision among this high-risk population.
    No preview · Article · Aug 2015 · Journal of Child Psychology and Psychiatry
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    ABSTRACT: It is now known that the onset of severe and recurring mental health problems begins for the most part before the age of 25: this provides a clear focus for preventive strategies and public mental health that are a feature of many health policy frameworks. The present distinction between child and adolescent mental health services and adult services at 16 or 18 does not fit easily with these data and the now well-documented problems of transition suggest that a fundamental review of services for young people is overdue. This supplement provides an overview of the epidemiological, conceptual and service structures for young people with emergent and existing mental health problems, and asks the question, 'How should we design services for young people to promote prevention and service engagement, and to improve outcomes?'
    No preview · Article · Jan 2013 · The British Journal of Psychiatry
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