Experience of child and adolescent mental health clinicians working within an at-risk mental state for psychosis service: a qualitative study

Aim: To qualitatively examine the common experiences of child and adolescent mental health clinicians working with adolescents suspected of having an ‘at‐risk mental state’ (ARMS) for psychosis. Methods: A semistructured interview was conducted with six experienced child and adolescent mental health clinicians working in North East England. Results: A thematic analysis of clinicians' experiences indicated that the identification and management of an ARMS within this patient group is particularly complex. In terms of treatment options, approaches that promoted social inclusion were favoured, but the use of antipsychotic medication was perceived as a ‘last resort’, requiring serious consideration. Clear guidelines and an overall consensus were judged to be lacking in terms of coordinating care and multi‐agency working practices. Conclusions: Establishing a formalized care pathway that also incorporates regular training and supervision may be required by this and other clinical services working with adolescents suspected of having an ARMS. Improved identification, a firmer evidence base regarding treatment practices and clear guidelines are required for this age group. This need will become more urgent should a psychosis risk syndrome be included as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐V).     

Attitudes toward standardized assessment tools and their use among clinicians in a public mental health service

Abstract

The aim of the present study was to investigate the use and attitudes toward standardized assessment tools among clinicians in a public mental health service in Norway. A total of 606 clinicians provided feedback on their use and attitudes regarding psychometric qualities of such tools, their practicality, and their benefit over clinical judgment alone using the Attitudes toward Standardized Assessment (ASA) Scales. Clinicians working in the adult mental health field scored significantly higher on use of diagnostic interviews, pre–post evaluations, and ongoing evaluations, whereas clinicians working in the child/adolescent mental health field scored significantly higher on use of screening instruments and held more positive attitudes towards using standardized assessment tools. Attitudes toward standardized assessment tools predicted use of such tools, and results were found to be similar to a study on US clinicians. Whereas the US study only found attitudes regarding the practicality of using such instrument as an independent predictor of assessment use, the current study found that attitudes regarding psychometric qualities of such tools, their practicality, and their benefit over clinical judgment alone were independent predictors of use.     

Developing needs led child and adolescent mental health services: issues and prospects

For many years mental health services for children have been developed incrementally with little attention to the needs of the local population. However, over the past decade there have been attempts to develop more rational ways of planning child mental health services. This paper describes the information required to develop a needs-led child mental health service and, within that context, discusses how priorities should be set. It will be suggested that although the assessment of needs for child and adolescent mental health services is still very haphazard, there is now a clear trend for the evaluation of clinical practice to become more systematic. At an individual level we know quite a lot about the efficacy of treatment and the measurement of outcomes. At the service level, several models of good practice are being specified and evaluated. Accepted: 16 September 1998     

Implementing telepsychiatry in an early psychosis service during COVID-19: Experiences of young people and clinicians and changes in service utilization

Aim

In response to the COVID-19 pandemic, our early psychosis program rapidly transitioned to telepsychiatry. This study examined the change in health service utilization and experiences of young people and clinicians in response to the implementation of telepsychiatry.

Methods

Mixed methodology and triangulation of evidence drawn from health service databases and survey data. Using a retrospective observational design, health service data from pre- (Time 1) and post-(Time 2) telepsychiatry periods were compared. Surveys were also conducted with representation from clinicians and young people.

Results

The number of appointments increased between Time 1 and 2, although this was accompanied by a near-doubling in missed appointments (8% to 13%). Young people had mixed views about telepsychiatry. While convenience was a frequently cited benefit, clients reported technological issues, isolation and lack of human connection. A preference for face-to-face appointments was linked to younger age and anxiety when using telepsychiatry. Clinicians reported improved workplace satisfaction and efficiency but noted some limitations in the use of telepsychiatry including difficulty interviewing and managing unwell clients remotely and called for greater skill development.

Conclusions

The introduction of telepsychiatry in response to COVID-19 was associated with an increase in service activity; however, there was an increase missed appointments by young people. Although clinicians and clients reported positive experiences, telepsychiatry was not completely endorsed as a replacement for face-to-face interactions.     

Establishing and operating an early intervention service for psychosis in a defined catchment area of northwestern Greece within the context of the local mental health network

Aim: The study aims to present briefly the development of an early intervention service (EIS) for psychosis in a rural catchment area of north‐western Greece within the context of the local mental health network, its structure and procedures, and the results of its operation 2 years after its establishment. Method: Established in December 2007, our EIS is the first service in Greece for patients with a first‐episode psychosis. The context and the local mental health network are described, and the EIS operation, including clinical, educational, community and research activities, is outlined. Assessment measures are presented to evaluate the EIS progress 2 years after its establishment. Results: Between December 2007 and December 2009, EIS received 45 referrals, retaining 38 patients in its caseload. The mean duration of untreated psychosis was 26.6 ± 41.0 months (median = 12 months). Thirty‐seven patients (82.2%) were hospitalized after their first referral, 14 under a compulsory order (31.1%). The duration of hospitalization ranged from 2 to 69 days, with a median of 13 days. Mean (±SD) duration of the follow‐up was 14.8 ± 8.5 months, indicating adequate adherence to EIS, with particularly low relapse rates (20%). Conclusions: Our EIS seems to be successfully established within the local mental health network. Our collaboration with the local mobile mental health unit enabled our communication with rural primary healthcare centers. The collaboration of patients' family and the participation of the mobile mental health unit to the continuity of care contributed greatly to the brief duration of hospitalization and the high adherence to follow‐up rates.     

Journey into and through an early detection of psychosis service: the subjective experience of persons at risk of developing psychosis

Aim: This study aimed to explore how persons who have been assessed as being at risk of developing psychosis make sense of and understand their experiences, using a qualitative approach. Methods: The sample comprised six female and four male participants (n = 10), ranging in age from 16 to 30 years, with a mean age of 21.8 years. All the participants had entered into a National Health Service Early Detection service in the North of England, which provides interventions for persons assessed as being at a high risk of developing psychosis. Individual semistructured interviews were conducted to study how persons at risk of developing psychosis construct their understanding and perception of their experiences. Results: The analyses identified three central themes: (i) ‘perception of needs’, which highlighted how participants recognized the need to enter services and how they identified what they required from the service; (ii) participants' subjective journey; and (iii) participants' orientation to the future. Conclusions: The journey described by participants assessed as being at risk of developing psychosis provides further insight into how persons make sense of their experiences from a qualitative ‘insider’ perspective. The findings are discussed in relation to the existing literature relating to the early detection and intervention of psychosis and clinical implications are identified.     

Youth at ultra high risk for psychosis: using the Revised Network Episode Model to examine pathways to mental health care

Aim: This paper aims to identify the ways in which youth at ultra high risk for psychosis access mental health services and the factors that advance or delay help seeking, using the Revised Network Episode Model (REV NEM) of mental health care. Methods: A case study approach documents help‐seeking pathways, encompassing two qualitative interviews with 10 young people and 29 significant others. Theoretical propositions derived from the REV NEM are explored, consisting of the content, structure and function of the: (i) family; (ii) community and school; and (iii) treatment system. Results: Although the aspects of the REV NEM are supported and shape pathways to care, we consider rethinking the model for help seeking with youth at ultra high risk for psychosis. Conclusions: The pathway concept is important to our understanding of how services and supports are received and experienced over time. Understanding this process and the strategies that support positive early intervention on the part of youth and significant others is critical.     

Recent trends in UK child and adolescent mental health

Background Past studies have documented rising levels of conduct problems among UK adolescents in the last quarter of the twentieth century, and increased rates of emotional difficulties between the 1980s and 1990s. Method We used parent, teacher and youth ratings from two large scale, nationally representative studies of 5–15 year-old carried out in 1999 and 2004 to assess whether these increases continued into the early years of the new millennium. Results Ratings on most “problem” sub-scales remained stable or showed small declines over this period, and parent and teacher reports suggested small increases in levels of prosocial behaviours. Conclusions The upward trends in rates of UK child adjustment problems noted since the 1970s and 1980s may have plateaued, and possibly begun to be reversed.     

Russian child mental health A cross-sectional study of prevalence and risk factors

Abstract Background The fall of communism and subsequent economic crises have been followed by major social and health problems. High rates of child mental health problems are frequently cited by the Russian media, though there is little relevant evidence. Aims The aim of this study was to investigate the prevalence and associations of child mental health problems in Russia using internationally recognised measures and diagnostic systems. Method A two-stage, two-phase cross-sectional survey of the mental health of 7- to 14-year-olds involved random sampling of schools, followed by random sampling of pupils from school lists. A sample of 448 children was obtained, representing an 83% participation rate. In the first phase, screening measures of psychopathology and risk were administered to parents, teachers and 11- to 14-year-olds. In the second phase, more detailed psychiatric assessments were carried out for subgroups of screen-positive and screen-negative children (N=172). Results The prevalence of psychiatric disorder was about 70% higher than that recently found in Britain with comparable measures, but there were few differences between Britain and Russia in type of disorder or key risk factors. Conclusion There is a pressing need for evidence-based mental health treatments to be made widely available to Russian children and adolescents.