Towards early intervention for youth mental health in primary care: a mixed methods investigation

In Ireland, psychological morbidity has been reported in 21-27% of young people and recent data has indicated that the youth suicide rate in Ireland is now the second highest (of 26 countries) in the European Union, for 0-19 year olds. Early intervention in youth mental health is increasingly viewed as easier, cheaper and more effective than traditional approaches to care. GPs, as the health care professional most often consulted by young people, have a central role in early detection of youth mental health and substance use problems. However, there is a dearth of evidence regarding the experiences and attitudes of young people and health care workers towards screening and treatment for mental and substance use disorders in primary care in Ireland. The overarching aim of this thesis was to examine the role of primary care (with a particular focus on the role of the GP) in providing early intervention and treatment for mental health and substance use problems in young people. It was a mixed methods study that involved qualitative interviews with health care workers (n=37) and young people (n=20) from primary care, secondary care and community agencies in two of Ireland’s most socio-economically disadvantaged areas, Limerick City and Dublin South Inner City and a national cross-sectional survey of GPs (n=175). The research found that while addressing youth mental health problems was a priority for most participants, a number of barriers to the identification and management of such issues were identified: access to services, flaws in traditional mental health services for young people under eighteen years, fragmentation between services and limited resources. The research outlined potential implications for clinical practice, research and education such as promoting awareness of mental health and the role of the GP in helping these issues, education of practitioners and improving access to psychological treatments for young people

Early intervention in youth mental health: development of guidelines for general practice

Aims: GPs, as healthcare professionals with whom young people commonly interact, have a central role in early intervention for youth mental health. To support GPs in this important role, we aim to develop clinical guidelines to promote identification and treatment of mental and substance use disorders among young adults (age 16-24). Methods: Following a qualitative study of young people and healthcare professionals in two urban deprived areas, we conducted a modified Delphi study using the following steps: i) Established an Expert Panel involving 18 key stakeholders; ii) Identified key areas which the guidelines should address using a group meeting and survey; iii) Reviewed and synthesised relevant literature; iv) Review of items created again by the stakeholder panel, with another meeting and survey. Results: Twenty-two items were considered important for inclusion in the guidelines and 17 items important for implementing them. These items could be divided into five different domains 1. Prevention, Health Promotion and Access; 2. Assessment and Identification; 3. Interaction with Other Agencies/Referral; 4. Ongoing Support; and 5. Implementation issues. Conclusions: Guidelines which would include all 22 items and 17 implementations would be too unwieldy for reasonable use by GPs. However, once split into the different domains, followed by further literature synthesis and review from the expert panel, it is hoped guidelines more applicable and feasible for use in practice will be created under these headings

GP attitudes towards screening and treating mental and substance use disorders in primary care.

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Can general practice help address youth mental health? A retrospective cross-sectional study in Dublin's south inner city

Aims: With general practice potentially having an important role in early intervention of mental and substance use disorders among young people, we aim to explore this issue by determining the prevalence of psychological problems and general practice/health service utilization among young people attending general practice. Methods: A retrospective cross-sectional study of patients attending three general practices in Dublin city. Results: Among a sample of young people (mostly women, 44% general medical services (GMS) eligible), we observed considerable contact with general practice, both lifetime and for the 2 years of the study. The mean consultation rate was 3.9 consultations in 2 years and psychosocial issues (most commonly stress/anxiety and depression) were documented in 35% of cases. Identification of psychosocial issues was associated with GMS eligibility, three or more doctor consultations, and documentation of smoking and drinking status. Conclusions: Psychosocial issues are common among young people attending general practice and more work on their epidemiology and further identification in general practice are advocated

Youth mental health in deprived urban areas: A Delphi study on the role of the GP in early intervention.

Background: GPs, as healthcare professionals with whom young people commonly interact, have a central role in early intervention for mental health problems. However, successfully fulfilling this role is a challenge, and this is especially in deprived urban areas. Aims: To inform a complex intervention to support GPs in this important role, we aim to identify the key areas in which general practice can help address youth mental health and strategies to enhance implementation. Methods: We conducted a modified Delphi study which involved establishing an expert panel involving key stakeholders / service providers at two deprived urban areas. The group reviewed emerging literature on the topic at a series of meetings and consensus was facilitated by iterative surveys. Results: We identified 20 individual roles in which GPs could help address youth mental health address youth mental health, across five domains: 1. Prevention, Health Promotion and Access, 2. Assessment and Identification, 3. Treatment Strategies, 4.Interaction with Other Agencies/Referral, and 5. Ongoing Support. With regard to strategies to enhance implementation, we identified a further 19 interventions, across five domains: 1.Training, 2. Consultation Improvements, 3. Service-Level Changes, 4. Collaboration, and 5.Healthcare-system Changes. Conclusions: GPs have a key role in addressing youth mental health and this study highlights the key domains of this role and the key components of a complex intervention to support this role

How social context impacts on the development, identification and treatment of mental and substance use disorders among young people - a qualitative study of health care workers

Introduction: Social context has a major influence on the detection and treatment of youth mental and substance use disorders in deprived urban areas, particularly where gang culture, community violence, normalisation of drug use and repetitive maladaptive family structures prevail. This paper aims to examine how social context influences the development, identification and treatment of youth mental and substance use disorders in deprived urban areas from the perspectives of health care workers. Method: Semi-structured interviews were conducted with health care workers (n=37) from clinical settings including: primary care, secondary care and community agencies and analysed thematically using Bronfenbrenner’s Ecological Theory to guide analysis. Results: Health care workers’ engagement with young people was influenced by the multilevel ecological systems within the individual’s social context which included: the young person’s immediate environment / ‘microsystem’ (e.g. family relationships), personal relationships in the ‘mesosystem’ (e.g. peer and school relationships), external factors in the young person’s local area context / ‘exosystem’ (e.g. drug culture and criminality) and wider societal aspects in the ‘macrosystem’ (e.g. mental health policy, healthcare inequalities and stigma). Conclusions: In deprived urban areas, social context, specifically the micro- meso- exo- and macro-system impact both on the young person’s experience of mental health or substance use problems and services which endeavour to address these problems. Interventions that effectively identify and treat these problems should reflect the additional challenges posed by such settings

Additional file 1: of Feasibility of alcohol screening among patients receiving opioid treatment in primary care

Short Alcohol and Alcohol Problems Perception Questionnaire. Questions designed to explore the attitudes of staff working with people with alcohol use disorders. (DOC 47 kb

Feasibility of alcohol screening among patients receiving opioid treatment in primary care

Background: Identifying and treating problem alcohol use among people who also use illicit drugs is a challenge. Primary care is well placed to address this challenge but there are several barriers which may prevent this occurring. The objective of this study was to determine if a complex intervention designed to support screening and brief intervention for problem alcohol use among people receiving opioid agonist treatment is feasible and acceptable to healthcare providers and their patients in a primary care setting. Methods: A randomised, controlled, pre-and-post design measured feasibility and acceptability of alcohol screening based on recruitment and retention rates among patients and practices. Efficacy was measured by screening and brief intervention rates and the proportion of patients with problem alcohol use. Results: Of 149 practices that were invited, 19 (12.8 %) agreed to participate. At follow up, 13 (81.3 %) practices with 81 (62.8 %) patients were retained. Alcohol screening rates in the intervention group were higher at follow up than in the control group (53 % versus 26 %) as were brief intervention rates (47 % versus 19 %). Four (18 %) people reduced their problem drinking (measured by AUDIT-C), compared to two (7 %) in the control group. Conclusions: Alcohol screening among people receiving opioid agonist treatment in primary care seems feasible. A definitive trial is needed. Such a trial would require over sampling and greater support for participating practices to allow for challenges in recruitment of patients and practices

Towards early intervention for youth mental health in primary care: a qualitative study of service provider perspectives in two deprived urban areas

Aims: Early intervention in youth mental health is increasingly viewed as easier, cheaper and more effective than traditional approaches to care. GPs, as the healthcare professional most often consulted by young people, have a central role in early detection of youth mental health and addiction disorders. However, international data suggests many young people have concerns bringing these issues to their GP, and GPs themselves experience difficulty identifying and treating mental health issues. The aim of this study is to gain an understanding of the experience of youth mental health and addiction treatment in two deprived urban areas to inform future early intervention practice development. Methods: Semi-structured interviews were recorded with 37 healthcare professionals. Inductive thematic analysis was carried out using QSR NVivo 9. Results: ‘Context’ suggests youth mental health issues are considerably influenced by wider societal context and local factors (e.g. family). Intervention suggests many barriers and enablers to helping young people, be that at the identification, treatment, or engagement stages of intervention. Conclusions: Many factors influence how a young person develops, seeks help for, and engages with treatment for mental and substance use disorders. This knowledge is useful in developing interventions in primary care that are specific to deprived urban areas

The role of context in youth mental health and addiction issues: a qualitative study on social deprivation in Limerick City and Dublin South Inner City

Introduction: Youth mental health (YMH) and addiction issues are a core component of the problems facing those living in urban areas of social deprivation in Ireland, in particular South Inner City Dublin and Limerick City 1,2. These local contexts, with histories of drug addiction, violence, family dissolution, suicide and gang-related criminality lend themselves to promote further criminal and addictive behaviour, as well as increased stress and decreased protective factors such as social support and education. Early intervention is considered a ‘best buy’ in mental health, but the current Irish system struggles to engage with young people and offer them appropriate treatment