The Youth Mental Health Network (YMHN) is driven and made up of a range of individuals and groups that are passionate about improving the mental health of young people, regardless of their background. The Youth Mental Health Network's vision is to improve the provision of youth mental health services by harnessing and fostering commitment to evidence based youth mental health services, in their various forms.

1. Research Evidence for
Service Improvement in
Youth Mental Health
YMHN Conference 24th June 2013
Rick Fraser – Sussex Partnership NHS Foundation Trust
Kathy Greenwood - Sussex Partnership NHS Foundation Trust

2. Where is the evidence?

3. What we do know
• 1 in 4 young people between 15-24 will experience a mental
disorder in any 12 month period
• 15 - 24 years old is the peak period for the onset of mental
disorders (75%)
• Mental health issues are responsible for 65 - 70% of Burden of
Disease for young people aged 15-24
• Mental and substance use disorders frequently coexist (70% of
help seeking cohorts)
• Pathways for young people to access health resources are limited
as use of standard GPs is under-represented in this age group
• Although most young people experience recovery from symptoms
of mental disorders, there is a significant negative impact on
longer term vocational pathways and economic participation
(Birchwood, Singh & McGorry, 2013)

4. We know what doesn’t work…

5. The spectrum model of illness

6. Disease Burden across Age
(McGorry, 2007)

7. MH Prevalence /Service Use Gap
greatest for young people
0
5
10
15
20
25
30
16-24 25-34 35-44 45-54 55-64 65-74 75-85
Percent
Age
Prevalence
Service Use
(McGorry, 2007)

8. Complex and confusing pathways (Farmer 2003)

9. ‘The system is weakest where it should be
strongest’ (McGorry 2007)

10. Transitions are problematic (Singh 2007)

11. Rationale for Youth Services
Adult mental health disorders begin in adolescence
Early intervention model
Preventive strategies
Developmental perspective
Access/engagement/retention
Appropriate setting/clinical staff/service configuration
Family involvement
Social/vocational
Economic
Reform

12. Evidence for Youth Services
Adult mental health disorders begin in adolescence – Insel
2005, Jones 2013
Early intervention – Mihalopoulos 2009, McGorry 2013
Preventive strategies – Yung 2013, Stallard 2013, Chanen 2013
Developmental perspective – Lamb 2013
Access/engagement/retention – Singh 2009
Appropriate setting/clinical staff/service configuration –
McGorry 2009
Family involvement – Bebbington 2011
Social/vocational – Killackey 2010
Economic – Knapp & McCrone 2010 (2013)
Reform - ???

13. Pulling the evidence together

14. 2nd IAYMH Conference Brighton 2013

15. What works and whats new in youth services?
Crawley
Pathfinder
Service

16. Headspace - Australia

17. Youth space - Birmingham

18. Ireland
Youth frie
Early
Accessible
Strengths/Resilience based
Communities, Schools
Mental Health Services,
young people, youth workers
doctors, psychologists, families,
Psychiatrists, sports coaches
Learning Network
Youth Café
Open Door sessions
Drop in/outreach
Jigsaw wraparound
Peer mentoring
Challenging Stigma
Health promotion
Youthreach (schools)

19. Somewhere to turn to, someone to talk to..
Vision
young people
connected and
resilient
Values
Respect for and
support for
good mental
health
Mission
Changing thinking
(through advocacy/
involvement/resear
ch/evaluation

20. Evaluation (Galway)
Service type (n=503)
information/brief
contact
case consultation
specific problem/brief
intervention
longer term goals
group work

21. Key features
• Youth participation
• Holistic, optimistic, preventative, shared decision-making
(risk/benefit)
• EI, social inclusion and vocational outcome target
• Reflect mental health epidemiology & developmental
youth culture
• Eliminate discontinuities and
• Promote seamless service links
McGorry, Bates and Birchwood 2013

22. Phase 1 focus groups/interviews
Young Service
users
N=22
Young People
N=22
Siblings/Parents
N=24
Sussex, Surrey and Kent
N=68 people
Early Youth Engagement in FEP (EYE)

23. Phase 1 engagement outcomes
Facilitators and Barriers to engagement
Barrier and Facilitator themes
Commun-
ication
servicetoserviceuser/
carer
Lackofinform-ation
Social
Family
Friend
Serviceusers
Stigma-barrier
Media-facilitator Mental health
service
serviceitself
medication
hosptial
Mental health Staff
Action
Attitude
Knowledge
Personal experience
MentalHealth
Behaviour
PersonalQualities
Socialenvironment

24. Phase 1 – Barriers/Facilitators
Information
“not knowing what will happen when I get help and what options I have…”
“Knowing that I am not alone and that there are millions of people that have the same
illness and people can help and how they can help.”
Fear of the service
“Being labelled as mental and losing control of my own life in terms of reliance on
drugs.”
Friends
“I think they might have helped me to engage with the services because they
reminded me that I had a place to get back to if you see what I mean like I’ve got a
goal you know.”
Intervention choices
“there are, you know, it’s also proven by experiments that you know human touch
releases Oxytocin, exercise releases endorphins”

25. Phase 2 Delphi to intervention?
EYE
model?
Myth busting &
informed
choice
intervention
information
booklets
Carer/School
Packs
Engagement
website
Improve GP
links
Active social
engagement
Friends, family,
peer worker
Transparent
Goal-focussed
engagement
Increased
choice of
activities

26. Crawley Youth Pathfinder
Started November 2012
1 team lead, 2 key workers
Training in conjunction with young people and based on
their responses
Approximately 30 young people seen to date
Most provided pathfinder support and guidance
10% supported to obtain specialist mental health
services

27. Where next: Developing the evidence base?
What do we need to show to keep this
going?
Economic and outcomes evaluation

28. www.sussex.ac.uk/spriglab
Thank you