This paper provides an overview of early intervention (EI) services for psychosis in Canada. We describe a leading Canadian EI program's approach to enhancing access (via early case detection, open referral, and rapid response) and providing specialized phase-specific treatment. Learnings from this program's research/evaluation indicate that EI can significantly improve service user and family engagement. Achieving and maintaining symptom remission (particularly negative symptoms) may be important for better social and occupational functioning in first-episode psychosis (FEP). Our program demonstrates the feasibility of establishing and sustaining an open referral, rapid-response system to address the chronic systemic problems of long waiting lists and barriers to access. We argue that an integrated clinical-research program based on specialized EI guidelines can significantly improve outcomes and advance FEP research.

PurposeWhile early access to appropriate care can minimise the sequelae of mental illnesses, little is known about how youths come to access mental healthcare. We therefore conducted a systematic review to synthesise literature on the pathways to care of youths across a range of mental health problems.MethodsStudies were identified through searches of electronic databases (MEDLINE, PsycINFO, Embase, HealthSTAR and CINAHL), supplemented by backward and forward mapping and hand searching. We included studies on the pathways to mental healthcare of individuals aged 11–30 years. Two reviewers independently screened articles and extracted data.ResultsForty-five studies from 26 countries met eligibility criteria. The majority of these studies were from settings that offered services for the early stages of psychosis, and others included inpatient and outpatient settings targeting wide-ranging mental health problems. Generally, youths’ pathways to mental healthcare were complex, involved diverse contacts, and, sometimes, undue treatment delays. Across contexts, family/carers, general practitioners and emergency rooms featured prominently in care pathways. There was little standardization in the measurement of pathways.ConclusionsExcept in psychosis, youths’ pathways to mental healthcare remain understudied. Pathways to care research may need to be reconceptualised to account for the often transient and overlapping nature of youth mental health presentations, and the possibility that what constitutes optimal care may vary. Despite these complexities, additional research, using standardized methodology, can yield a greater understanding of the help-seeking behaviours of youths and those acting on their behalf; service responses to help-seeking; and the determinants of pathways. This understanding is critical to inform ongoing initatives to transform youth mental healthcare.Electronic supplementary materialThe online version of this article (10.1007/s00127-018-1578-y) contains supplementary material, which is available to authorized users.

A cognitive-behavioral program with a goal of either abstinence or controlled drinking was assessed. The 70 early-stage problem drinkers were randomly assigned to one of the two goal conditions, and within each condition to one of two therapists. On average they received six individual weekly sessions, each lasting approximately 90 min. Both groups were taught to indentify risk situations and existing competencies, to develop cognitive and behavioral coping, and to assess their progress objectively. The controlled-drinking group was also taught procedures for moderate drinking. Over the 2-year follow-up period, no significant differences were found between the groups in reported alcohol consumption. Six months after treatment drinking had been reduced from an average of about 51 drinks per week to 13, and this reduction was maintained throughout the second year. Reports of drinking were corroborated by independent measures. Although the outcomes of the groups were similar, controlled drinking was considered to be a more suitable goal; it was more acceptable to the majority of the clients, and most of those assigned to abstinence developed moderate drinking on their own. The authors wish to thank the following colleagues for their contributions to the project: C. Milton-Feasby and V. Ittig-Deland for conducting intake and follow-up assessments, B. Sisson for medical screenings, Y. Israel for recommending the biochemical corroborators of alcohol consumption, and B. Kapur for conducting the laboratory analyses. Special appreciation is extended to H. Lei for his advice on statistical analyses and to D. A. Wilkinson, K. D. Walker, H. A. Skinner, and C. Poulos for their valuable feedback and support.Requests for reprints should be sent to M.

Objectives. To develop a sustainable formal faculty mentoring program to support professional development of new faculty members at the Massachusetts College of Pharmacy and Health Sciences. Methods. Program components included a mentorship subcommittee, faculty mentoring guidelines, protégé/mentor pairs, an orientation, seminars/workshops, and meetings between mentor/protégés pairs. Preparticipation and postparticipation questionnaires about the faculty mentoring program were used to assess changes in perceived level of abilities of protégés and mentors in areas of teaching, service, and scholarship. Results. After 5 years, 93 protégés and 73 mentors have participated in the faculty mentoring program. Program evaluations were largely positive. Self-perceived abilities of protégés increased in all areas addressed, program self-study, faculty recruitment, grant application preparation, program development, and promotion process. Perceived abilities of mentors also showed some increases following the faculty mentoring program. Conclusion. Both protégés and mentors can benefit from mentoring relationships. Faculty mentoring programs are important for faculty development and retention and achievement of academic and institutional goals.

Suffering is a core experience of FEP from which a range of positive changes can follow among service users and their families and friends. It may be beneficial for mental health services to specifically strive to promote these positive changes.