Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review

MacDonald, Kathleen; Ferrari, Manuela; Fainman-Adelman, Nina; Iyer, Srividya N.

doi:10.1007/s00127-020-01976-9

Cited by 41 publications

(51 citation statements)

References 85 publications

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“…Specifically, our findings surrounding importance of prior care experience or training, including that pertaining to mental health care generally and that specific to care transitions, highlight the importance of prioritizing educational opportunities for providers, caregivers and individuals to optimize the care transition process. This is consistent with data noting the influence of prior care experiences and training in transition practices on other types of mental health care transitions [ 22 , 29 ]. Across the system or policy and organizational levels, this could include prioritization or funding enabling continued provider education regarding evidence-based care transitional practices and provision of educational outreach aimed at promoting knowledge and competency in mental health transitions [ 128 , 129 ].…”

Section: Discussionsupporting

confidence: 91%

“…In youth, for example, there are significant efforts to characterize determinants and improve the transition from child to adult mental health services [ 17 , 19 , 21 , 24 – 26 ] as well as youth pathways to mental health care more generally (e.g. [ 27 – 29 ]). Those studies specifically focused on the transition from inpatient mental health care in youth largely target school transitions, with limited emphasis on the transition to non-school based mental health services [ 30 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

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Characterization of multilevel influences of mental health care transitions: a comparative case study analysis

Dickson

Sklar

Chen

et al. 2022

BMC Health Serv Res

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Purpose Mental health care transitions are increasingly prioritized given their potential to optimize care delivery and patient outcomes, especially those focused on the transition from inpatient to outpatient mental health care. However, limited efforts to date characterize such mental health transition practices, especially those spanning multiple service setting contexts. Examination of key influences of inpatient to outpatient mental health care transitions across care contexts is needed to inform ongoing and future efforts to improve mental health care transitions. The current work aims to characterize multilevel influences of mental health care transitions across three United States-based mental health system contexts. Methods A comparative multiple case study design was used to characterize transition practices within the literature examining children’s, non-VA adult, and VA adult service contexts. Andersen’s (1995) Behavioral Health Service Use Model was applied to identify and characterize relevant distinct and common domains of focus in care transitions across systems. Results Several key influences to mental health care transitions were identified spanning the environmental, individual, and health behavior domains, including: community capacity or availability, cross-system or agency collaboration, provider training and experience related to mental health care transitions, client care experience and expectations, and client clinical characteristics or complexity. Conclusions Synthesis illustrated several common factors across system contexts as well as unique factors for further consideration. Our findings inform key considerations and recommendations for ongoing and future efforts aiming to plan, expand, and better support mental health care transitions. These include timely information sharing, enhanced care coordination and cross setting and provider communication, continued provider/client education, and appropriate tailoring of services to improve mental health care transitions.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Characterization of multilevel influences of mental health care transitions: a comparative case study analysis

Dickson

Sklar

Chen

et al. 2022

BMC Health Serv Res

View full text Add to dashboard Cite

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“…The youth MHSU service sector is fragmented, with many service access barriers: long wait times, a lack of service coordination and integration, unfacilitated transitions from child/adolescent to adult service systems, and stigma [4][5][6][7][8] . The pathways into care are complex and far from streamlined [9][10][11] , creating additional service access barriers.…”

Section: Introductionmentioning

confidence: 99%

Youth Perspectives on Integrated Youth Services: A Discrete Choice Conjoint Experiment

et al. 2021

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Objective Integrated youth services (IYS) are an emerging model of care offering a broad range of mental health and social services for youth in one location. This study aimed to determine the IYS service characteristics most important to youth, as well as to determine whether different classes of youth have different service preferences, and if so, what defines these classes. Methods Ontario youth aged 14–29 years with mental health challenges were recruited to participate in a discrete choice experiment (DCE) survey. The DCE contained 12 attributes, each represented by 4 levels representing core characteristics of IYS models. To supplement the DCE questions, demographic information was collected and a mental health screener was administered. Preferences were examined, latent class analyses were conducted, and latent classes were compared. Results As a whole, participants endorsed the IYS model of service delivery. Among 274 youth, there were three latent classes: 1) the Focused Service (37.6%) latent class prioritized efficient delivery of mental health services. 2) The Holistic Services (30.3%) latent class prioritized a diverse array of mental health and social services delivered in a timely fashion. 3) The Responsive Services (32.1%) latent class prioritized services that matched the individual needs of the youth being served. Differences between classes were observed based on sociodemographic and clinical variables. Conclusions IYS is an acceptable model of care, in that it prioritizes components that reflect youth preferences. The differences in preference profiles of different groups of youth point to the need for flexible models of service delivery. Service design initiatives should take these preferences into account, designing services that meet the needs and preferences of a broad range of youth. Working locally to co-design services with the youth in the target population who wish to be engaged will help meet the needs of youth.

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“…A qualitative meta-synthesis of the experience of pathways to MH services highlight that patients and their caregivers often do not know what resources exist, experience difficulties with narrow eligibility criteria, and report lack of discharge planning after hospitalization and multiple unwanted service interruptions. 41 Navigating the system after the initial contact may prove to be a challenge for several patients, especially for those who have behaviors that can be perceived as disturbing or aggressive and be rejected by services. The present findings show that, while some receive sustained MH care, improving the integration of services to reduce fragmentation and service discontinuity may improve the quality of services received for many, and possibly reduce the need for forensic MH services.…”

Section: Discussionmentioning

confidence: 99%

Care Pathways, Health Service Use Patterns and Opportunities for Justice Involvement Prevention Among Forensic Mental Health Clients

et al. 2022

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Objectives The objective of the present study is to describe the patterns of health service use and of prescription claims in the year preceding an offense leading to a verdict of not criminally responsible on account of a mental disorder (NCRMD). Methods Provincial health administrative databases were used to identify medical services, hospitalizations, and ambulatory prescription claims among 1,014 individuals found NCRMD in Québec. Contacts in the year preceding the offense were analyzed using descriptive analyses and latent class analysis. Results Overall, 71.4% of subjects were in contact with services for mental health reasons within a year of their NCRMD offense. Among those that received services and not hospitalized for psychiatric reasons at the time of the offense, 20.7% committed the NCRMD offense within a week of the most recent mental health contact. Among those that had at least one prescription claim for an antipsychotic, 45.8% were not taking any antipsychotic at the time of the offense. Latent class analysis provided a multidimensional representation of mental health service use and showed that 58.4% of subjects had no or very rare contact with services. Conclusions Many forensic patients are likely to have experienced service disruption or discontinuity while in the community, for reasons that may relate to perceived need for care, to service organization, or to the acceptability, availability, and accessibility of services. Given the serious impact of the “forensic” label on the lives of service users, not to mention the increased pressure on resources, the considerable economic costs, and the impact on victims, there is reason to advocate for a greater involvement of mental and physical health service providers in early prevention of violence, which requires reorganizing resources to share the forensic knowledge upstream, before an offense is committed.

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Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review

Abstract: Author contribution statement: K.M. and SN.I contributed to the conception and design of the research question. K.M and N.F.A. were involved in data collection. All authors contributed to data analysis and interpretation, as well as drafting and revising the manuscript.

Cited by 41 publications

References 85 publications

Characterization of multilevel influences of mental health care transitions: a comparative case study analysis

Characterization of multilevel influences of mental health care transitions: a comparative case study analysis

Youth Perspectives on Integrated Youth Services: A Discrete Choice Conjoint Experiment

Care Pathways, Health Service Use Patterns and Opportunities for Justice Involvement Prevention Among Forensic Mental Health Clients

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