Integrated Programs for Early Recognition of Severe Mental Disorders: Recommendations From an Italian Multicenter Project

Abstract

The onset of mental disorders often occurs in adolescence or young adulthood, but the process of early diagnosis and access to timely effective and appropriate services can still be a challenge. The goal of this paper is to describe a pilot case of implementation of the ultra-high-risk (UHR) paradigm in six Italian departments of mental health employing an integrated approach to address clinical practice and service organization for youth in a broader preventive perspective. This approach entailed the integration of the UHR paradigm with a service provision model which prioritizes prevention and the promotion of local community coalitions to improve youth service accessibility. The multicenter Italian project “Integrated programs for recognition and early treatment of severe mental disorders in youths” funded by the National Centre for Disease Prevention and Control (CCM2013 Project) implemented in three Italian regions will be described. As a result of synergic actions targeting accessibility of young individuals to innovative youth mental health teams, a total of 376 subjects aged 15–24 years were recruited by integrated youth services within 12 months. Subjects have been screened by integrated multidisciplinary mental health youth teams employing standardized procedure and evidence-based clinical assessment instruments for at-risk mental states in young subjects [e.g., Comprehensive Assessment of At-Risk Mental States (CAARMS)]. Considering the three UHR categories included in CAARMS, the percentage of UHR subjects was 35% (n = 127) of the sample. In conclusion, future strategies to improve the organization of youth mental health services from a wider preventive perspective will be proposed.

Public health primary prevention implemented by clinical high-risk services for psychosis

“… Domains Interventions Demographic Service characteristics • Anti-stigma and youth-friendly community setting and service delivery. [ 17 , 20 , 35 , 44 , 52 , 53 , 65 ] • Flexible outreach approach to enhance engagement of young people. [ 37 , 65 ] • Presence in catchment areas with high levels of ethnic minorities.…”

“…[ 30 ] Selective strategies and corresponding good mental health domains • Recreational therapy, activities or support. [ 43 , 52 , 53 , 57 , 58 , 77 ] QoL, family and significant relationships Environmental events Service characteristics • Presence in catchment areas with high levels of refugees and asylum seekers. [ 29 ] • Community engagement projects focused on asylum seekers and refugees.…”

“…[ 77 ] Mental health literacy, attitude towards mental disorders • Education, awareness and anti-stigma campaigns for community organisations. [ 19 , 20 , 22 , 27 , 29 , 30 , 32 , 36 – 38 , 40 , 43 , 44 , 53 , 56 , 57 , 63 , 66 , 77 – 79 ] Mental health literacy, attitude towards mental disorders • Training and mental health awareness for professionals working with young people. [ 19 , 20 , 22 , 24 , 27 , 29 , 32 , 35 – 38 , 40 , 44 , 45 , 49 , 50 , 52 , 54 , 56 , 57 , 62 – 64 , 68 – 70 , 72 , 73 , 75 , 77 – 79 ] Mental health literacy, attitude towards mental disorders Selective strategies and corresponding good mental health domains • Problem-solving training.…”

Clinician stakeholder experiences of a new youth mental health model in Australia: A qualitative study

“…Co‐location is a feature of many youth mental health services, with ‘youth hubs’ and ‘one stop shops’ used to address barriers to accessing care (Abba‐Aji et al, 2019; Hilferty et al, 2015; Hodgekins et al, 2017; McGorry et al, 2019; Morgan et al, 2019; Parabiaghi et al, 2019). hEIT is co‐located within a youth and family‐friendly headspace setting, with access to collaborative services, and was perceived by clinician participants as more accessible for young people than specialist mental health services.…”

“…New models of care featuring low stigmatizing youth‐friendly services to improve access, with primary and secondary prevention goals, have been developed internationally, including Australia (Hilferty et al, 2015; Orygen, National Centre of Excellence in Youth Mental Health, 2018), Canada (Abba‐Aji et al, 2019), Italy (Parabiaghi et al, 2019), New Zealand (Morgan et al, 2019) and the United Kingdom (Hodgekins et al, 2017). A 2019 review of youth mental health ‘hubs’, found common principles including rapid access to evidence based care, youth‐friendly services and settings, youth and family engagement, and partnerships and collaboration (Settipani et al, 2019).…”