Young people's participation in their own mental health care: Session-by-session feedback in youth mental health services (headspace).

AIM: Young people's participation in their own mental healthcare requires ways for them to provide feedback to their clinicians on how they are experiencing their treatment. Key dimensions of session experience are willingness to attend, feeling listened to and understood, working on issues important to them, feeling hopeful for the future and feeling that things are improving in their lives. This study reports on young people's session experiences over time and by key demographics for headspace youth mental health services. METHODS: The sample comprised 16 484 young people aged 12-25 years who commenced an episode of care at one of the 150 headspace centres between 1 July 2021 and 30 June 2022 and who had attended at least two services. Data were collected via the routinely collected headspace minimum data set. RESULTS: Overall, young people reported very positive session experiences over all the session dimensions. Few demographic differences were found: session ratings were more positive for young adults (18+ years) compared with adolescents (under 18 years). Scores on all five dimensions improved with more visits, and willingness to attend and working on issues important to the young person were strong predictors of service engagement. Better session experience scores were associated with more positive ratings of quality of life. CONCLUSIONS: Young people experience their headspace sessions very positively, and more positive experiences are associated with better service engagement and quality of life. Routinely collecting session feedback gives young people a valuable way to participate in and inform their own care.

Inequitable access to mental healthcare for socially excluded adolescents.

BACKGROUND: Adolescence is a critical period for mental health and social exclusion, a key social determinant of mental health. Early intervention approaches are key to mitigating the impact of mental ill-health during adolescence, however social exclusion can create additional barriers to accessing care. AIM: We aimed to better understand help-seeking experiences of adolescents facing co-occurring social exclusion and mental ill-health, including sources of support, barriers and preferences for service provision. METHOD: Cross-sectional data were analysed, from the 2022 Mission Australia Youth Survey (N = 18,800). Adolescents aged 15 to 19 years were recruited from around Australia, through schools, community organisations and digital platforms. Indices of four domains of social exclusion (housing, finances, relational and education/employment) were created using existing Youth Survey variables, and supplemented with demographic characteristics, psychological distress and help-seeking behaviours (perceived need, mental health supports, barriers to access and preferences). Relationships between social exclusion domains, mental health concerns and help-seeking behaviours were explored using logistic regression models. RESULTS: A total of 9,743 young people reported having needed mental health support, yet only 58.1% reportedly sought support (n = 5,565). Social exclusion domains were associated with different help-seeking behaviours: housing challenges with higher help-seeking (OR = 1.28; 95% CI [1.15, 1.42]); relational difficulties and edu-employment issues with lower (OR = 0.75; 95% CI [0.68, 0.83] and OR = 0.82; 95% CI [0.75, 0.89]). Stigma, confidentiality concerns, cost and not knowing where to seek help were common barriers to help-seeking; those experiencing social exclusion more likely to report these. Participants reported a strong preference for face-to-face support. CONCLUSIONS: This study highlights the additional needs and challenges faced by adolescents dealing with both social exclusion and mental ill-health. With greater barriers to help-seeking, concerted efforts are needed to reduce stigma, improve mental health literacy and increase access to trusted information sources. Further initiatives should focus on structural factors that socially exclude young people and exacerbate inequitable access to mental healthcare.

Integrated care models for youth mental health: A systematic review and meta-analysis.

OBJECTIVES: To evaluate the effectiveness of integrated models of mental healthcare in enhancing clinical outcomes, quality of life, satisfaction with care and health service delivery outcomes in young people aged 12-25 years. A secondary objective was to identify common components of integrated mental health interventions. METHODS: A systematic review and meta-analysis of studies published 2001-2023 that assessed clinical or health service use outcomes of integrated care, relative to treatment as usual, for any mental health condition in 12-25 years old accessing community-based care. RESULTS: Of 11,444 titles identified, 15 studies met inclusion criteria and 6 studies were entered in the meta-analysis. Pooled effect size found integrated care was associated with a greater reduction in depressive symptoms relative to treatment as usual at 4-6 months (standardised mean difference = -0.260, 95% confidence interval = [-0.39, -0.13], p = 0.001). Of the seven studies reporting access or engagement, all reported higher rates of both in the intervention arm. The most frequent components of integration were use of a multidisciplinary team (13/15 studies), shared treatment planning (11/15) and workforce training in the model (14/15). CONCLUSIONS: Integrated models of mental healthcare are associated with a small, but significant, increase in effectiveness for depressive symptoms relative to treatment as usual. Given integrated care may increase access and engagement, future research should focus on assessing the impact of integrated care in a wider range of settings and outcomes, including clinical and functional recovery, satisfaction with care and system-level outcomes such as cost-effectiveness.

Supporting Adolescents Bereaved by Suicide or Other Traumatic Death: The Views of Counselors.

Adolescents bereaved by suicide and other traumatic death may experience strong grief reactions and increased risks of mental health problems and suicidal behaviour. As timely access to professional help can be critical, it is essential to understand how counselors perceive suicide bereavement in adolescents and how they work with this population. This study aimed to examine the perspectives of counselors (N = 34). Eleven participated in an individual semi-structured interview and 23 others in group interviews. Thematic analysis yielded three themes: (1) Building a relationship with the bereaved adolescent, (2) Offering support tailored to the needs of the grieving adolescent, and (3) Offering strengths-based and sustainable support. Counselors' skills, attitudes, content-related expertise, and approaching the adolescent's grief within their developmental context were deemed essential for building a therapeutic relationship and offering viable support. The findings may inform good practices in counseling bereaved adolescents to facilitate positive mental health outcomes.

Examining the psychometric properties of the headspace Youth (mental health) Service Satisfaction Scale in a mental health service in Ireland.

INTRODUCTION: Evaluating service quality and satisfaction is central to the provision of accessible and developmentally appropriate youth mental health services. However, there are limited suitable measures and a lack of published evidence on the psychometric properties of measures to assess young people's satisfaction with youth mental health services. The headspace Youth (Mental Health) Service Satisfaction Scale (YSSS) was designed and implemented to assess young people's satisfaction with headspace mental health services in Australia. This study examined the reliability and factor structure of the YSSS in a youth mental health service in Ireland. METHODS: The sample comprised 1449 young people (66.2% female) aged 12-25 years (M = 16.48, SD = 2.97). Participants completed the YSSS after their final brief intervention session through Jigsaw-The National Centre for Youth Mental Health. Confirmatory factor analysis (CFA) was performed on one- and four-factor models to test findings from previous studies. Reliability was also examined. RESULTS: CFA supported a single-factor structure of the YSSS, and all items were suitable for inclusion. The internal consistency of the measure was deemed acceptable (α = 0.89). CONCLUSIONS: Findings suggest that the YSSS is a reliable measure for monitoring satisfaction with youth mental health services in an Irish context. The measure demonstrated a unidimensional construct of satisfaction. These findings support the broader application of the YSSS and add to existing knowledge on measuring satisfaction within youth mental health services.

What Is a Crisis? Perspectives of Crisis Support Help-Seekers.

Background: Understanding what types of crises help-seekers view as relevant for contacting crisis support services is needed to inform crisis service provision and training. Aims: This study aimed to explore help-seeker perceptions of what comprises a crisis, describing the main themes and examining how these relate to reasons for contact reported in previous research. This study further aimed to compare perceptions of what comprises a crisis between suicide-related and nonsuicide-related help-seekers. Method: As part of a larger online survey, Lifeline help-seekers (n = 375) responded to an open-ended question about their perceptions of personal crisis. Results: Thematic analysis identified 15 crisis themes. The most endorsed by all participants were family and relationship issues, mental health issues, and assault/trauma. Suicide-related help-seekers were more likely to identify suicidality as a crisis, whereas nonsuicide-related help-seekers were more likely to identify general life stress as a crisis. Limitations: The self-selected convenience sample limits generalizability. Conclusion: Help-seekers perceive crisis as a complex concept comprising many themes, with some similarities and differences between suicide-related and nonsuicide-related help-seekers. The findings may inform crisis helplines in promoting and tailoring their services to better meet user needs.

Development and Validation of a Routine Session-by-Session Experience Measure for Youth Mental Health Services: My Youth Mental Health Session Experience (MySE).

Purpose: The 'My youth mental health Session Experience' (MySE) measure was developed by headspace, Australia's National Youth Mental Health Foundation, in collaboration with young people, for use as a routine session experience measure across its national centre service network. The measure fills a gap in measures needed to implement measurement-informed care in youth mental health care. Participants and Methods: Routinely collected data from 37,201 young people aged 12 to 25 years who commenced an episode of care at one of the 150 headspace centres between 1 July 2021 and 30 June 2022 were used to validate the five-item measure. Results: MySE demonstrated high internal consistency invariant over age and gender groups. There was one latent factor of session experience that all MySE items relate to, although this factor does not adequately capture all the information present in the individual items. A significant age effect showed that young adults reported more positive session experiences than adolescents. Conclusion: MySE demonstrated strong psychometric properties and is suitable for use in youth mental health care as a routine session-by-session experience measure. Such measures are needed to routinely inform clinicians of how young people are experiencing their treatment sessions, thereby contributing to better retention, engagement, and client outcomes through measurement-informed care.

The effect of survey administration mode on youth mental health measures: Social desirability bias and sensitive questions.

Aim: Research on trends in youth mental health is used to inform government policy and service funding decisions. It often uses interviewer-administered surveys, which may be affected by mode effects related to social desirability bias. This study sought to determine the impact of survey administration mode on mental health measures, comparing mode effects for sensitive mental health measures (psychological distress and wellbeing) and non-sensitive (physical activity) measures. Methods: Data were from two large national community samples of young Australians aged 12-25 years conducted in 2020 (N = 6238) and 2022 (N = 4122), which used both interviewer-administered and self-report modes of data collection. Results: Results showed participants reported lower psychological distress and higher wellbeing in the interviewer-assisted compared with the self-report mode. No mode effects were found for the non-sensitive physical activity measures. No interaction between mode and gender was found, but an age group by mode interaction revealed that those in the 18-21 and 22-25-year age groups were more strongly affected than younger adolescents. Conclusions: These findings suggest underestimates of mental health issues from interview survey formats, particularly for young adults. The results show how even a weak mode effect can have a large impact on mental health prevalence indicators. Researchers and policy makers need to be aware of the impact social desirability bias can have on mental health measures and consider taking steps to mitigate this effect.

Social disadvantage in early psychosis and its effect on clinical presentation and service access, engagement and use.

Incidence of psychosis varies geographically due to factors such as social disadvantage. Whether this influences the clinical presentation and/or engagement of those experiencing psychosis remains relatively understudied. This study analysed data from young people across Australia accessing ultra-high risk (UHR) or first episode psychosis (FEP) services delivered through the headspace Early Psychosis (hEP) program between June 2017 and March 2021. The cohort was categorised into low, middle, and high tertiles of social disadvantage using the Index of Relative Socioeconomic Disadvantage (IRSD). Data from 3089 participants aged 15-25 were included (1515 UHR, 1574 FEP). The low and middle tertiles for both cohorts had greater percentages of those not in education or employment (NEET), with First Nations or culturally and linguistically diverse backgrounds. Clinical presentations to services were similar across all tertiles in both cohorts, however, functioning at presentation varied significantly within the FEP cohort. Significantly lower numbers of direct services were provided in the low tertile of both cohorts, with significantly poorer engagement in the initial three-months also occurring for these young people. This variation in early psychosis service patterns associated with geographical variation in social deprivation demonstrates the need for further research and fine tuning of national early psychosis services.

The experiences of parents in an early-intervention program for young people with borderline personality disorder features.

Previous research demonstrates that parents' communication skills may contribute to the development and maintenance of their young person's borderline personality disorder (BPD). Carers of people with BPD also experience their own psychosocial stressors and feel unsupported. Consequently, Dialectical Behavior Therapy for adolescents (DBT-A) invites parents to partake in group therapy alongside their young person. Despite this involvement, little research exists examining parents' perspective of engaging in a DBT-A program, and specifically whether they experience their own benefits and changes from being part of the program. To examine this, the current study interviews 34 parents who engaged in an early intervention DBT-A program. Thematic analysis resulted in seven key themes and 16 subthemes beginning with parents' expectations of the program, followed by the key elements of the program that facilitated change, and the actual changes and benefits attributed to these elements. Overall, parents were surprised by their own gains from the program, and how the skills they learned facilitated personal development that improved family communication and functioning with their young person and more broadly. This study addresses the gap in understanding the parent perspective with clinical implications for the benefits of involving parents in therapy more generally.

Sixteen years of innovation in youth mental healthcare: Outcomes for young people attending Australia's headspace centre services.

Australia's headspace initiative is world-leading in nation-wide youth mental healthcare reform for young people aged 12 to 25 years, now with 16 years of implementation. This paper examines changes in the key outcomes of psychological distress, psychosocial functioning, and quality of life for young people accessing headspace centres across Australia for mental health problems. Routinely collected data from headspace clients commencing an episode of care within the data collection period, 1 April 2019 to 30 March 2020, and at 90-day follow-up were analysed. Participants came from the 108 fully-established headspace centres across Australia, and comprised 58,233 young people aged 12-25 years first accessing headspace centres for mental health problems during the data collection period. Main outcome measures were self-reported psychological distress and quality of life, and clinician-reported social and occupational functioning. Most headspace mental health clients presented with depression and anxiety issues (75.21%). There were 35.27% with a diagnosis: overall, 21.74% diagnosed with anxiety, 18.51% with depression, and 8.60% were sub-syndromal. Younger males were more likely to present for anger issues. Cognitive behavioural therapy was the most common treatment. There were significant improvements in all outcome scores over time (P<0.001). From presentation to last service rating, over one-third had significant improvements in psychological distress and a similar proportion in psychosocial functioning; just under half improved in self-reported quality of life. Significant improvement on any of the three outcomes was shown for 70.96% of headspace mental health clients. After 16 years of headspace implementation, positive outcomes are being achieved, particularly when multi-dimensional outcomes are considered. A suite of outcomes that capture meaningful change for young people's quality of life, distress and functioning, is critical for early intervention, primary care settings with diverse client presentations, such as the headspace youth mental healthcare initiative.

The Australian Early Psychosis Collaborative Consortium (AEPCC): Improving Clinical Care in Early Psychosis.

OBJECTIVES: The field of early psychosis has undergone considerable expansion over the last few decades and has a strong evidence base of effectiveness. Like all areas of healthcare, however, early psychosis services need to more consistently deliver higher quality care to achieve better outcomes for patients and families. A national clinical research infrastructure is urgently required to enable the sector to deliver the highest quality care and expand and translate evidence more quickly and efficiently. This paper describes the establishment of the Australian Early Psychosis Collaborative Consortium (AEPCC) that aims to achieve this. CONCLUSION: AEPCC is the first of its kind in Australia (and internationally). It will deliver the required clinical research infrastructure through the implementation of a clinical quality registry, clinical trials and translation network, and lived experience network. AEPCC will provide a critical resource to better understand the state of early psychosis care, and trial new interventions on a scale that has not previously been possible in Australia.

Accelerating youth mental health services research.

OBJECTIVE: We describe a research program to advance youth mental health service research in Australia, addressing two core knowledge gaps: the lack of available routine outcome measures and lack of understanding of how to assess and monitor complexity and heterogeneity in illness presentation and trajectory. CONCLUSIONS: Our research identifies better routine outcome measures (ROM) that are: designed specifically for the developmental nuances of the 12-25-year age range; multidimensional; and meaningful to young people, their carers, and service providers. Alongside much-needed new measures of complexity and heterogeneity, these tools will inform service providers to better meet the needs of young people presenting with mental health problems.

Understanding the complexity, patterns, and correlates of alcohol and other substance use among young people seeking help for mental ill-health.

PURPOSE: Use of alcohol and other substances is a multifaceted issue impacting young people across multiple life domains. This paper aims to elucidate patterns of substance use and associated demographic and clinical factors among young people seeking treatment for their mental health. METHODS: Young people (12-25 years old) were recruited from five youth-specific primary mental health ("headspace") services in Australia. Self-reported substance use and harms in the past 3 months were measured using WHO-ASSIST. Network analyses were conducted to evaluate interrelationships between use and harms associated with different substances. Subgroups were then identified based on whether participants reported using high centrality substances, and associated demographic and clinical factors were assessed with multinomial logistic regression. RESULTS: 1107 youth participated. 70% reported use of at least one substance in the past 3 months, with around 30% of those reporting related health, social, legal or financial problems. Network analysis highlighted substantial interconnections between use and harm indicators for all substances, with amphetamine-type stimulants (ATS) and cannabis being high central substances. Higher levels of substance use and harms were reported in subgroups with ATS or cannabis use and different risk factors were associated with these subgroups. CONCLUSIONS: Findings highlight the importance of screening for substance use in youth primary mental healthcare settings, offering a key opportunity for early intervention. Clinicians should be aware of the inner connections of use and harms of different drugs and the role of cannabis and amphetamine use as a marker for more substance use profiles.

Inequalities in Access to Mental Health Treatment by Australian Youths During the COVID-19 Pandemic.

OBJECTIVE: The authors aimed to evaluate changes in use of government-subsidized primary mental health services, through the Medicare Benefits Schedule (MBS), by young people during the first year of the COVID-19 pandemic in Australia and whether changes were associated with age, sex, socioeconomic status, and residence in particular geographical areas. METHODS: Interrupted time-series analyses were conducted by using quarterly mental health MBS service data (all young people ages 12-25 years, 2015-2020) for individual Statistical Area Level 3 areas across Australia. The data captured >22.4 million service records. Meta-analysis and meta-regression models estimated the pandemic interruption effect at the national level and delineated factors influencing these estimates. RESULTS: Compared with expected prepandemic trends, a 6.2% (95% CI=5.3%-7.2%) increase was noted for all young people in use of MBS mental health services in 2020. Substantial differences were found between age and sex subgroups, with a higher increase among females and young people ages 18-25. A decreasing trend was observed for males ages 18-25 (3.5% reduction, 95% CI=2.5%-4.5%). The interruption effect was strongly associated with socioeconomic status. Service uptake increased in areas of high socioeconomic status, with smaller or limited uptake in areas of low socioeconomic status. CONCLUSIONS: During 2020, young people's use of primary mental health services increased overall. However, increases were inequitably distributed and relatively low, compared with increases in population-level mental health burden. Policy makers should address barriers to primary care access for young people, particularly for young males and those from socioeconomically disadvantaged backgrounds.

Prevalence and Correlates of Tobacco Use in Young People Presenting to Australian Primary Mental Health Services.

INTRODUCTION: In Australian youth primary mental health settings it is unclear as to the rates and correlates of tobacco use at service entry. AIMS AND METHODS: We aimed to delineate the prevalence and correlates of recent tobacco use (eg, cigarettes, chewing tobacco, cigars, etc) in the past 3 months in young people at their first presentation to primary mental health services as a function of age. Cross-sectional self-report measures were collected using a tablet device from young people presenting to one of five Australian primary mental health (headspace) services. Logistic regression assessed correlates of past 3-month tobacco use in adolescents (12-17 years) and young adults (18-25 years). RESULTS: Regular (at least monthly) tobacco use in the past 3 months was found in 23.4% (n = 247, N = 1055) of the sample. Increasing age (odds ratio [OR] =1.47 per year; 95% confidence interval [CI]: 1.15 to 1.89), male sex (OR = 1.98; 95% CI: 1.02 to 3.83), being in a relationship (OR = 1.96; 95% CI: 1.01 to 3.82), and poorer functioning (OR = 0.95 per unit Social and Occupational Functioning Assessment Scale increase; 95% CI: 0.91 to 0.99) predicted regular tobacco use in adolescents, but not in young adults. Living in a regional location (OR = 2.10; 95% CI: 1.40 to 3.13) and not studying (OR = 0.47; 95% CI: 0.31 to 0.73) predicted tobacco use in young adults. Having a diagnosed mental illness other than depression and/or anxiety predicted tobacco use in both groups (adolescents OR = 2.49; 95% CI: 1.26 to 4.94; young adults OR = 1.80; 95% CI: 1.13 to 2.89). CONCLUSIONS: Nearly a quarter of young people with mental illness are using tobacco, supporting the need for early intervention approaches. Adapting treatment targets by age could improve the impact of interventions in adolescents versus young adults. Poor functioning and lack of engagement in education were associated with tobacco use in both age groups, respectively; however, more research is needed to determine the direction of these relationships. IMPLICATIONS: Young people with mental illness have a high prevalence of recent tobacco use and this is evident when they first present to youth primary mental health services. Youth-oriented mental health settings may provide a unique window for tobacco use prevention and early intervention to reduce smoking in people with mental illness, a priority population. Age-specific targeted approaches might be needed in adolescents and young adults.

Autonomy versus support: self-reliance and help-seeking for mental health problems in young people.

PURPOSE: Many young people with mental ill-health do not seek support, and developmental growth in self-reliance may be a barrier to help-seeking. Increasing autonomy is a positive developmental task for youth and a key aspect of resilience. This study examined the influence of perceived social support and resilience on the previously unexamined relationship between self-reliance and intentions to seek help from informal, professional, and self-help sources for mental health problems. METHODS: An online survey was completed by a representative Australian community sample of 5,203 young people aged 12-25 years (half female), in May-June 2020. RESULTS: Path analysis showed the hypothesised conceptual model did not fit the data well, but a modified model was a good fit. Higher self-reliance was associated with lower intentions to seek informal and professional help, as expected, but not with greater intentions for self-help. The relationship between self-reliance and informal help-seeking intentions was fully mediated by perceived social support, whereas the relationship between self-reliance and professional help-seeking was also direct. Perceived social support fully mediated the relationship between self-reliance and resilience. Intentions to use self-help were not influenced by variables in the study, but higher self-help intentions were associated with higher professional help-seeking intentions. Associations were consistent across age and gender groups. CONCLUSION: The results show the critical role of social support for combating some of the unhelpful aspects of self-reliance for mental health help-seeking in young people. Future research should explore how self-reliance can hinder or be harnessed to facilitate accessing appropriate mental health.

Structured data vs. unstructured data in machine learning prediction models for suicidal behaviors: A systematic review and meta-analysis.

Suicide remains a leading cause of preventable death worldwide, despite advances in research and decreases in mental health stigma through government health campaigns. Machine learning (ML), a type of artificial intelligence (AI), is the use of algorithms to simulate and imitate human cognition. Given the lack of improvement in clinician-based suicide prediction over time, advancements in technology have allowed for novel approaches to predicting suicide risk. This systematic review and meta-analysis aimed to synthesize current research regarding data sources in ML prediction of suicide risk, incorporating and comparing outcomes between structured data (human interpretable such as psychometric instruments) and unstructured data (only machine interpretable such as electronic health records). Online databases and gray literature were searched for studies relating to ML and suicide risk prediction. There were 31 eligible studies. The outcome for all studies combined was AUC = 0.860, structured data showed AUC = 0.873, and unstructured data was calculated at AUC = 0.866. There was substantial heterogeneity between the studies, the sources of which were unable to be defined. The studies showed good accuracy levels in the prediction of suicide risk behavior overall. Structured data and unstructured data also showed similar outcome accuracy according to meta-analysis, despite different volumes and types of input data.