High integrity mental health services for children: focusing on the person, not the problem

Wolpert, Miranda; Vostanis, Panayotis; Martin, Keith L.; Munk, Simon; Norman, Rob; Fonagy, Peter; Feltham, Amy

doi:10.1136/bmj.j1500

Cited by 20 publications

(19 citation statements)

References 13 publications

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“…Whether a wide range of interventions to support and address mental health problems in youth might be possible, including approaches that do not rely on specialist professional input, is also of interest. 8 The consideration of non-professionally mediated responses to depression and anxiety in youth is important for four reasons. First, not all those who accessed specialist help measurably improved symptoms of functioning.…”

Section: Introductionmentioning

confidence: 99%

Strategies not accompanied by a mental health professional to address anxiety and depression in children and young people: a scoping review of range and a systematic review of effectiveness

Wolpert

Dalzell

Ullman³

et al. 2019

The Lancet Psychiatry

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This Review reports on a scoping review followed by a systematic review to consider interventions designed to address or manage depression or anxiety in children and young people up to the age of 25 years without the need to involve mental health professionals. The scoping review identified 132 approaches, 103 of which referred to children or young people (younger than 25 years). These approaches included social interaction, engagement with nature, relaxation, distraction, sensory stimulation, physical activity, altering perceptions, engaging in hobbies, self-expression, and exploration. A systematic review of effectiveness studies from the literature identified in the scoping review found only 38 studies on seven types of intervention that met the inclusion criteria. 16 studies were based on cognitive or behavioural principles (15 on digital interventions and one on bibliotherapy), ten focused on physical exercise, five on light therapy, three on dietary supplements, two on massage therapy, one on online peer support, and one on contact with a dog. Most studies focused on adolescents or young adults. Evidence suggested that light therapy could be effective for season depression and that digital interventions based on attention bias modification are ineffective for anxiety. Mixed evidence was available on the effectiveness of computerised cognitive behavioural therapy for depression and anxiety, and of physical exercise for depression. All other studies had insufficient certainty to obtain even tentative conclusions about effectiveness. These results highlight the disparity between the extensive range of approaches identified in the scoping review and the restricted number and focus found in the systematic review of effectiveness of these approaches. We call for an expanded research agenda that brings evaluation rigour to a wide range of self or community approaches. Target population identified in the literature Letting oneself be loved Children and young people Unsupported or unguided computer-based attention bias modification Children and young people Unsupported or unguided computer-based attention bias modification of interpretations Children and young people Unsupported or unguided computer-based problemsolving therapy Children and young people Unsupported or unguided computer-based cognitivebehavioural analysis of system psychotherapy Children and young people Unsupported or unguided computer-based worry exposure Children and young people Unsupported or unguided computer-based audio-photic stimulation Children and young people Unsupported or unguided computer-based systematic desensitisation Children and young people Robots Children and young people Apologising to others Children and young people Avoiding conflict or stressful situations at home Children and young people Thinking about things Children and young people Challenge the negative feelings Children and young people Notice triggers Children and young people Goal-setting Children and young people Small actions to release tension Children and young ...

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Section: Introductionmentioning

confidence: 99%

Strategies not accompanied by a mental health professional to address anxiety and depression in children and young people: a scoping review of range and a systematic review of effectiveness

Wolpert

Dalzell

Ullman³

et al. 2019

The Lancet Psychiatry

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show abstract

“…To be accommodating, to use humor, and to dare to act personally were used as examples. One adolescent advised therapists on how to establish a trusting relationship: (10) Equally important was the therapists' trust in the adolescents. The experience of being believed, no matter what, was emphasized in several interviews.…”

Section: To Gain Trustmentioning

confidence: 99%

I’m not a diagnosis: Adolescents’ perspectives on user participation and shared decision-making in mental healthcare

Bjønness

Grønnestad

Storm

2020

Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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Background: Adolescents have the right to be involved in decisions affecting their healthcare. More knowledge is needed to provide quality healthcare services that is both suitable for adolescents and in line with policy. Shared decision-making has the potential to combine user participation and evidence-based treatment. Research and governmental policies emphasize shared decision-making as key for high quality mental healthcare services. Objective: To explore adolescents' experiences with user participation and shared decision-making in mental healthcare inpatient units. Method: We carried out ten in-depth interviews with adolescents (16-18 years old) in this qualitative study. The participants were admitted to four mental healthcare inpatient clinics in Norway. Transcribed interviews were subjected to qualitative content analysis. Results: Five themes were identified, representing the adolescents' view of gaining trust, getting help, being understood, being diagnosed and labeled, being pushed, and making a customized treatment plan. Psychoeducational information, mutual trust, and a therapeutic relationship between patients and therapists were considered prerequisites for shared decision-making. For adolescents to be labeled with a diagnosis or forced into a treatment regimen that they did not initiate or control tended to elicit strong resistance. User involvement at admission, participation in the treatment plan, individualized treatment, and collaboration among healthcare professionals were emphasized. Conclusion: Routines for participation and involvement of adolescents prior to inpatient admission is recommended. Shared decision-making has the potential to increase adolescents' engagement and reduce the incidence of involuntary treatment and re-admission to inpatient clinics. In this study, shared decision-making is linked to empowerment and less to standardized decision tools. To be labeled and dominated by healthcare professionals can be a barrier to adolescents' participation in treatment. We suggest placing less emphasis on diagnoses and more on individualized treatment.

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“…Wolpert et al () concluded that one in 10 children worldwide experience ‘mental health difficulties that substantially affect their lives' (p. 1). Factors that contribute to this phenomenon continue to be identified and discussed.…”

Section: Overviewmentioning

confidence: 99%

Impact of parental mental illness on children's HoNOSCA results in a regional child and adolescent mental health service

Naughton

Maybery

Sutton

et al. 2019

Int J Mental Health Nurs

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Use of routine outcome measures are frequently used to ascertain improvement in children's symptomology, this study examined whether living with a parent with a mental illness impacted outcome measures. The study examined 134 children attending a Child and Adolescent Mental Health Service (CAMHS). The majority lived with a parent reporting mental illness. Routine HoNOSCA and CGAS outcome measures were collected over a 6‐month period. Children of parents with a mental illness scored higher on most outcome measures. All children improved on most variables over the 6 months of CAMHS intervention with children of parents with mental illness showing greater improvement compared to other children on behaviour but less improvement on all other variables. They did not, however, improve as much on education‐related factors and showed lower improvement in overall functioning. Younger children with a parent with a mental illness improved least in the area of behaviour. This study highlighted the need for greater use and integration of measures where children live with a parent who has a mental illness. Findings suggest parental mental illness impacted on overall child outcomes, and this influence remained irrespective of clinical intervention. The common occurrence of parental mental illness, where children also have a mental illness, indicates focusing on a wider set of outcome measures for more effective intervention. Analysis of a larger cohort sample is warranted.

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High integrity mental health services for children: focusing on the person, not the problem

Cited by 20 publications

References 13 publications

Strategies not accompanied by a mental health professional to address anxiety and depression in children and young people: a scoping review of range and a systematic review of effectiveness

Strategies not accompanied by a mental health professional to address anxiety and depression in children and young people: a scoping review of range and a systematic review of effectiveness

I’m not a diagnosis: Adolescents’ perspectives on user participation and shared decision-making in mental healthcare

Impact of parental mental illness on children's HoNOSCA results in a regional child and adolescent mental health service

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