Evaluating Youth Mental Health Service Models from around the

Globe

Dr Rick Fraser Consultant Psychiatrist and Clinical Lead Sussex Early Intervention in

Psychosis Service

SHA Youth Event, Gatwick 17/04/12

Youth Mental Health Services ModelBackground

• 1 in 4 young people b/w 15-24 will experience a mental disorder in any 12 month period (Sawyer, 2000)

• 15 - 24 years old is the peak period for the onset of mental disorders (McGorry 2004)

• Mental health issues are responsible for 65 - 70% of Burden of Disease for young people aged 15-24 (AIHW 2007)

• Mental and substance use disorders frequently coexist (70% of help seeking cohorts) ( NSW Health 2007)

• Most young people experience recovery from symptoms of mental disorders, however there is a significant negative impact on longer term vocational pathways and economic participation (Zubrick, 2000)

‘The system is weakest where it needs to be strongest’ (McGorry, 2010)

Transitions

• Education compulsory to 16• Youth justice system works with children and

young people aged between 10 and 17• CAMHS up to 18• Children’s services are generally provided up

to the age of 19• Children in care can continue to receive

services until the age of 21, or 25 if they are in education

Transitions

• TRACK study (Singh et al, 2009). – 4 out 90 made ‘optimal’ transition from CAMHS to

AMHS• Confusing system• Different eligibility criteria• Different language• Varying involvement of family

What does research tell us?

• Community-based resources which are friendly, informal, flexible, accessible and non-stigmatising

• Flexibility in venues and meeting times (including out of hours, and drop-ins without appointments), plus telephone support

• Flexibility and perseverance if appointments are missed

• Services that respond to unexpected changes in the young person’s mental health and other aspects of their lives(Mental health service transitions for young people. Brodie et al, 2011)

Options

Stay as we are

• Cheaper?• System works well enough…• No need to create more interfaces!

• BUT – not meeting the needs of young people • Likely to be increasing demands with greater

youth unemployment, higher costs of living fewer opportunities

Other models

Stand alone

• Health led?• Specialist

• Makes less use of collaborations/partnerships• More stigmatising?

Integrated

• Partnerships• Co-located• Less stigmatising• Skill-mix and upskilling

• Multiple funding streams potentially more difficult but may be more sustainable

Virtual

• Cheaper• Acknowledges need for youth services• Could be built on as funding becomes available

• BUT – not based on meeting needs of young people

• Unstable and easily dismantled• Governance/risk issues• ‘Tick box’

Modular

• Access• Acute• Community• Specialist clinics eg EIP, mood disorders, eating

disorders

• A place to begin and grow?

Where to start?

• Build on existing services eg EIP, CAMHS, 3rd sector, Primary Care?

• Collaboration critical in current economic climate

• Research and evaluate• Build networks eg YMH Network

Primary Secondary Tertiary

Current Health Service System for Young People

PRIMARY CARE(GPs, School counsellors, CHCs etc) Specific education for proactive case-finding and non-complex treatment

LOCAL COMMUNITY Awareness Campaigns, eHealth, & Mental Health First Aid

Broad Youth Mental & Substance Use Disorder Focus

“headspace”

Youth Services Platform

SPECIFIC DISORDER FOCI

Specialist Mental Health & SUD services: ideally blended and youth-focused

Training and SupervisionNetworks

Referral from any source

Youth portalInitial generic assessment

Signpost out

Young Persons ServiceClinical assessment & allocation of PA

+/- Brief InterventionRefer out eg GP, 3rd

sector, SMS etc

CAMHSAMHS

Youth Access and Transition model(16-25 year olds in Crawley)

Evaluation

• Evaluation of transitions difficult & complex (Haber et al, 2008)

• Outcomes– Employment– Education– Criminal justice involvement– Mental health– Substance use

• Older individuals did better• Females did better than males

Evaluation – age ranges

• Headspace (Australia) 12-25• Orygen (Australia) 15-25• Youthspace (Birmingham) 14-25• Headstrong (Ireland) 12-25

Motivation to change

• Survey of all PCTs (Pugh, 2005)• 40% CAMHS commissioners and 26% of AMHS

commissioners wanted to develop youth mental health services

• 15% provided age-specific services• Increasing interest more recently

Future

• Youth health firmly on agenda• Building locally• No ‘one size fits all’• Involve young people, carers/families, local

organisations• Start small and grow• Network – build links• Explore collaborations and funding streams

Thank You