Real-Time Needs, Real-Time Care: Creating Adaptive Systems of Community-Based Care for Emerging Adults

Abstract

Research indicates a decline in mental health service utilization between the ages of 16 to 25, leaving emerging adults with mental illness at risk for worsening outcomes. The authors utilized a community-based participatory research (CBPR) approach to explore the mental health landscape for youth aged 16–25 in London, Canada. Interviews and focus groups (n = 30) with community and hospital system leaders, youth and caregivers were transcribed and coded using an approach informed by constructivist grounded theory. There was consensus regarding difficulties in the current system including wait times and crisis-driven services leading to powerlessness among youth and caregivers. Solutions include delivery of services through a flexible, real-time system that emphasizes patient and caregiver engagement, youth centric services and recovery-oriented care across the hospital/community continuum. The results highlight that disparate stakeholders agree regarding the need for transformational change shifting away from traditional medical models.

Experiences and satisfaction of children, young people and their parents with alternative mental health models to inpatient settings: a systematic review

“…The final sample comprised of 19 articles included in this review and provides outcome evidence in the following four domains: alternative models [21,26,27,29,30]; interventions applied to Crisis [22,[31][32][33]; telepsychiatry and mobile applications applied to mental health crisis [35,38,39,41]; and experience and satisfaction with mental health crisis provision [25,28,34,36,37,40].…”

“…The best way to summarise the parental experiences would be to describe their journey through the crisis services as 'battling through the system' [37]. Similar experiences were shared by CYP, who characterised their experiences as difficult, 'in crisis and out of control', struggle to get any help from the crisis services, and being judged by the staff members [28,40]. Besides, short appointments were often seen as a negative experience while being honest was perceived as damning [34,40].…”

“…The 19 studies included in this review came from 5 different countries; 8 studies came from the UK [21,22,[25][26][27][28][29][30], 5 from the US [31][32][33][34][35], 3 from Australia [36][37][38], 2 from Canada [39,40] and 1 from Denmark [41]. Eight studies utilised a qualitative methodology [25,28,29,34,[36][37][38]40] and two studies were based on a qualitative case-study approach [22,33]. In contrast, three studies followed a quantitative descriptive approach [30,35,39], while one study had a mixed-methods design [26].…”

“…Furthermore, parents reported experiences of high burden as a consequence of dealing with a CYP who are undergoing a mental health crisis and crisis service itself at the same time. High level of carers burden was often associated with a sense of isolation, suffering, and feelings of being abandoned by the crisis provider while travelling through the crisis care system [40].…”

“…Moreover, a lack of understanding or choice, coupled with the sense of being lost in the system, a consequence of being thrown between different crisis assessment services and not being listened or understood are themes that commonly expressed by both parents and CYP. Furthermore, often staff changes are reported both in CYP and parental experiences, which consequently created an impact on the therapeutic alliance, as well as a need to tell their story on multiple occasions [40]. Additionally, parents and carers often characterised their experiences as terrifying or traumatic [25], while being rejected by the crisis services on several occasions due to staff perceptions that their child is not in crisis or not experiencing relapse [25,37].…”