"It cannot be boring!": Developing a measure of function for young adults accessing integrated youth services.

BACKGROUND: In Canada, the prevalence of mental health challenges is highest in young people aged 12-24. Mental health challenges frequently cause marked functional impairment. Despite this, we are unaware of any existing conceptualization and/or measures of function that has been developed from the perspective of young people. The objective of this paper is to develop a conceptual and measurement model, including a preliminary set of items, for an outcome measure of function for young adults accessing mental health services. METHODS: We conducted this study in three phases. In phase 1, we conducted three focus groups to conceptualize function as a construct from the perspective of young adults. In phase 2, we co-designed a set of items with youth (n = 4) to capture the construct. In phase 3, we invited young people (n = 12) accessing mental health services to complete workbooks and participate in one of two focus groups to evaluate whether items were clear, captured function comprehensively, and were relevant. We transcribed and compiled all data to eliminate, refine and generate new items. RESULTS: In phase 1, a conceptual model of function was developed with three main themes: basic needs, roles and responsibilities, and social connections. In phase 2, 97 candidate items were developed, and in phase 3, a candidate pool of 50 items resulted for psychometric testing. CONCLUSION: This youth-centred conceptualization of function and preliminary item bank has the potential to advance person-centred care, outcomes, and experiences for youth seeking mental health services.

"I Felt Supported by the Peers in My Group": Analyzing Experiences of Youths with Mental Health Challenges of a Supported Employment Program in Canada.

PURPOSE: The objectives of this study were to gain an understanding of the experiences of youths with mental health conditions who have undergone a 16-week supported employment program (SEP) conducted in an urban centre in Canada. METHODS: Focus groups and individual semi-structured interviews were used to capture the experience of youths who had completed the program. Youths were eligible if they were aged 19 to 30 years diagnosed with a mental illness and enrolled in the program. Purposeful sampling was used to recruit participants. Thematic analysis was conducted to analyze the data. Primary codes were organized and mapped onto Donebedian's Structure-Process-Outcome Model. RESULTS: Altogether, 34 participants, aged 17 to 30 years old, described their experiences participating in this 16-week supported employment program. Participants' experiences of this program and with employment were categorized into four main themes focusing on the (1) structure of program, (2) process of care (3) outcomes of program, and (4) improvements to the program. CONCLUSION: Overall, the experience of a supported employment program was perceived as valuable, with unexpected benefits of the program beyond employment including the establishment of routine, friendship, and self-confidence. The proposed model can be used as a structure for monitoring and evaluating SEP.

Social determinants of health and depression in adults presenting to the emergency department: Implications for family medicine.

OBJECTIVE: To estimate the extent to which social determinants of health (SDH) predict levels of depression in adults presenting to the emergency department (ED) with an acute mental health crisis. DESIGN: Secondary data analysis. SETTING: St Paul's Hospital, an urban tertiary care hospital in Vancouver, BC. PARTICIPANTS: Patients 19 years and older presenting to the ED with an acute mental health crisis. MAIN OUTCOME MEASURES: Responses to demographic questionnaires focused on SDH and to measures of self-perceived health and depression. Relationships between depression and SDH were described using t tests and χ 2 tests. The extent to which SDH variables predicted depression scores, as measured by the Patient Health Questionnaire-9 (PHQ-9), was determined using linear regression. RESULTS: The primary study had 202 participants. Data for the 156 (77%) participants who completed the PHQ-9 were assessed in this secondary analysis. In this sample, 60% of participants identified as men, 37% as women, and 4% as other. The mean (SD) age was 39.1 (13.8) years, with most participants identifying as white (65%) or Indigenous (18%). Thirty-seven percent had a high school diploma or less education, and 72% reported being unemployed. Identifying as a woman, lack of access to clean drinking water, poor food security, feeling unsafe, little structured use of time, lack of a sense of community, and dissatisfaction with housing significantly predicted higher depression scores. Overall, 59% of respondents met the criteria for moderately severe or severe depression (PHQ-9 score ≥ 15), with 37% of those reporting thoughts of suicide nearly every day for the past 2 weeks. CONCLUSION: This study demonstrates the importance of screening for both depression and SDH in the ED. Because the ED often does not have the capacity to address appropriate levels of follow-up for this population, this study has important implications for primary care. Developing a clear pathway of follow-up support for people with depression and SDH risk factors will be critical to optimize patient outcomes, promote patient safety, enhance patient satisfaction, and optimize the use of resources between the ED and primary care.

Health provider and service-user experiences of sensory modulation rooms in an acute inpatient psychiatry setting.

BACKGROUND: Sensory modulation rooms (SMRs) are therapeutic spaces that use sensory modulation concepts and strategies to assist service users to self-regulate and modulate arousal levels. SMRs are increasingly being explored as strength-based and person-centered adjuncts to care for people receiving inpatient psychiatry services. The aim of this study is to understand health provider and inpatient service user perceptions on the use of SMRs on acute psychiatric units. METHODS: We conducted semi-structured interviews with ten service users and nine health providers (four occupational therapists and five nurses) regarding their experiences of the SMRs located on three acute inpatient units in a large urban tertiary care hospital. We audio recorded and transcribed the focus groups and used thematic analysis to analyze the data. RESULTS: Our results suggested four common themes amongst health provider and service user experiences of sensory modulation rooms: (1) service user empowerment through self-management, (2) emotional regulation, (3) an alternative to current practices, and (4) health provider and service user education. CONCLUSION: Our study supports the ecological utility of SMRs as person-centred adjunct therapeutic space viewed positively by both service users and health providers. This understanding of SMRs is critical for future service design, research and policy aimed at improving the service user experience and care for this population. Future research is needed to validate the experience of the SMRs with other patient groups and health providers.

Understanding the mental health and recovery needs of Canadian youth with mental health disorders: a Strategy for Patient-Oriented Research (SPOR) collaboration protocol.

BACKGROUND: While considerable progress is being made to understand the health and self-management needs of youth with mental health disorders, little attention has focused on the mental health and recovery needs that the youth themselves identify-this despite a national priority to incorporate patient-oriented research into the development and assessment of mental health services. To address this gap, estimates of the extent to which existing patient-reported outcome measures (PROMs)-originally developed for use amongst adult populations-are clinically meaningful and psychometrically fit for use among youth are needed. In tandem, a recovery profile for youth can be constructed incorporating the youth perspective of the services provided within a community mental health setting. METHODS/DESIGN: This study will utilize a mixed methods design incorporating qualitative focus group interviews and cross-sectional survey. Our process will begin with the hiring of a youth peer research partner who will provide lived experience expertise through all phases of the study. We will advertise, recruit, and conduct four focus groups with youth who receive services from the Foundry Vancouver Granville located in British Columbia, Canada. In the first two focus groups, we will recruit youth aged 15-18 years (n = 10). In the second two focus groups, we will recruit young adults aged 19-24 years (n = 10). In parallel, we will conduct a cross-sectional survey of the recovery and mental health needs of youth, informed by ten widely used and validated PROM. Thematic analysis techniques will guide the identification of predominant thematic trends in the qualitative focus group data. We will use Classical and Rasch measurement methods to test and analyze the reliability and validity of selected PROM measures for youth populations. DISCUSSION: The proposed study has the potential to produce a preliminary conceptual and measurement model for understanding the mental health and recovery needs of youth with mental health disorders. This evidence will inform how youth mental health services can grow, support, and sustain the capacity for a collaborative, interdisciplinary and innovative patient-oriented research environment. Findings will also contribute much needed evidence to improve the standard of care for youth who experience mental health disorders in Canada and beyond.

Barriers and facilitators to employment for young adults with mental illness: a scoping review.

OBJECTIVES: The issue of gaining employment for those with mental illness is a growing global concern. For many in the young adult population, who are at a transitional age, employment is a central goal. In response, we conducted a scoping review to answer the question, 'What are the barriers and facilitators to employment for young adults with mental illness?' DESIGN: We conducted a scoping review in accordance to the Arksey and O'Malley framework. We performed a thorough search of Medline, EMBASE, CINAHL, ABI/INFORM, PsycINFO and Cochrane. We included studies that considered young adults aged 15-29 years of age with a mental health diagnosis, who were seeking employment or were included in an employment intervention. RESULTS: Our search resulted in 24 research articles that focused on employment for young adults with mental illness. Four main themes were extracted from the literature: (1) integrated health and social services, (2) age-exposure to employment supports, (3) self-awareness and autonomy and (4) sustained support over the career trajectory. CONCLUSIONS: Our review suggests that consistent youth-centred employment interventions, in addition to usual mental health treatment, can facilitate young adults with mental illness to achieve their employment goals. Aligning the mental health and employment priorities of young adults may result in improved health and social outcomes for this population while promoting greater engagement of young adults in care.

Clinical and functional characteristics of young adults living in single room occupancy housing: preliminary findings from a 10-year longitudinal study.

OBJECTIVE: Young adults living in single room occupancy (SRO) hotels, a form of low-income housing, are known to have complex health and substance problems compared to their peers in the general population. The objective of this study is to comprehensively describe the mental, physical, and social health profile of young adults living in SROs. METHODS: This study reports baseline data from young adults aged 18-29 years, as part of a prospective cohort study of adults living in SROs in Vancouver, British Columbia, Canada. Baseline and follow-up data were collected from 101 young adults (median follow-up period 1.9 years [IQR 1.0-3.1]). The comprehensive assessment included laboratory tests, neuroimaging, and clinician- and patient-reported measures of mental, physical, and social health and functioning. RESULTS: Three youth died during the preliminary follow-up period, translating into a higher than average mortality rate (18.6, 95% CI 6.0, 57.2) compared to age- and sex-matched Canadians. High prevalence of interactions with the health, social, and justice systems was reported. Participants were living with median two co-occurring illnesses, including mental, neurological, and infectious diseases. Greater number of multimorbid illnesses was associated with poorer real-world functioning (ρ = - 0.373, p < 0.001). All participants reported lifetime alcohol and cannabis use, with pervasive use of stimulants and opioids. CONCLUSION: This study reports high mortality rates, multimorbid illnesses, poor functioning, poverty, and ongoing unmet mental health needs among young adults living in SROs. Frequent interactions with the health, social, and justice systems suggest important points of intervention to improve health and functional trajectories of this vulnerable population.