Evaluation of a community-based brief intervention service for youth in crisis with suicidal ideation or self-harm.

AIM: To evaluate the implementation of a mixed virtual and in-person brief intervention for young people, aged 12-25 years, presenting to a large urban mental health service in crisis with suicidal ideation and/or self-harm. METHODS: A pragmatic, real-world evaluation was conducted on the Youth Brief Intervention Service between June 2021 (inception) and October 2022. Service users were offered four sessions over an approximate one-month period. Sessions focused on distress tolerance, safety plans and support systems. Implementation outcomes related to service uptake, retention, fidelity of the model and service user experience. Effectiveness outcomes were measured pre-post and included mental health-related hospital service utilization (primary outcome), functioning, mental health status, self-harm, suicidal ideation and quality of life. RESULTS: Of the 136 young people referred to the Youth Brief Intervention Service, 99 were accepted with 17 disengaging before the first session. Eighty percent of people who commenced, completed the package of care. Young persons' and parent/carers experience of service was high (97% and 88%, respectively). Mental health-related emergency department presentations and inpatient days decreased from 3 months pre-intake to 3 months post-intake (42 vs. 7 presentations, X2 = 25.3, p < .001; 11 vs. 0 inpatient days, X2 = 9.1, p = .01). There were significant improvements in mental health status, days engaging in self-harm, general health and functioning and quality of life. CONCLUSIONS: The Youth Brief Intervention Service is feasible, acceptable, subjectively beneficial and coincided with less mental health-related emergency department presentations and inpatient days, and improved mental health status and behaviour.

The prevalence of mental illness in young people in custody over time: a comparison of three surveys in New South Wales.

Few studies have examined the prevalence of mental illness in young people over time within the same jurisdiction. In the current study, we compared data from three large surveys of youth in custody in New South Wales, conducted in 2003, 2009 and 2015. We examined rates of mental illness, self-harm and suicidal behaviours, substance use and childhood trauma and found little consistent change over time, though some fluctuations were observed regarding certain mental illnesses and substance use. We also descriptively compared findings with observed rates for the general population and found that young people in custody showed higher levels of all examined variables. In sum, these data suggest little improvement in the well-being of young people in custody in New South Wales over time. Better identification and treatment of these issues are vital if young people are to be prevented from becoming enmeshed in the criminal justice system.

Psychiatric admissions in young people after expiration of criminal justice supervision in Australia: a retrospective data linkage study.

BACKGROUND: Mental health services are available for young people involved with the criminal justice system. However, they have unmet mental health needs after the expiration of criminal justice supervision. OBJECTIVE: To determine the incidence rate and identify predictors of psychiatric hospitalisations within 24 months after the expiration of criminal justice supervision among young people involved with the New South Wales (NSW) criminal justice system. METHODS: Retrospective data from 1556 individuals aged 14-22 years who participated in four surveys of justice-involved young people in NSW were harmonised and linked to four NSW data collections. We calculated the incidence rates of psychiatric hospitalisations within 24 months postsupervision and identified predictors of these hospitalisations using a competing risks regression analysis. RESULTS: Within 24 months postsupervision, 11.4% had a psychiatric hospitalisation compared with 3.5% during supervision. 20.7% of those admitted had a known history of mental illness and engaged with community-based and outpatient mental health services postsupervision. Predictors of psychiatric hospitalisations were: female sex (adjusted subdistribution HR (asHR) 1.84, 95% CI 1.24 to 2.73); previous incarceration (highest asHR for ≥4 episodes 1.67, 95% CI 1.01 to 2.78); head injury (asHR 1.63, 95% CI 1.20 to 2.21); personality disorder (asHR 3.66, 95% CI 2.06 to 6.48) and alcohol and substance use disorder (asHR 1.89, 95% CI 1.29 to 2.77). CONCLUSION: Justice-involved youth have higher rates of psychiatric admissions after criminal justice supervision. Engagement with mental health services postsupervision is important in addressing emerging or persisting mental health needs.

Implementing a new adolescent epilepsy service: Improving patient experience and readiness for transition.

AIM: To implement and appraise a new model of care in terms of: patient experience, knowledge of epilepsy, readiness for transition and emotional and behavioural support in a new purpose-built facility for adolescents and young adults. METHODS: The new model of care included: upskilling of neurology staff in adolescent engagement and provision of group education sessions on epilepsy and mental health (MH), along with MH support, in a new purpose-built adolescent facility. Parameters examined pre- and post-attendance at the new clinic included: adolescent experience of service delivery, transition readiness, emotional and behavioural well-being, epilepsy knowledge and medication adherence. RESULTS: A total of 45 adolescents (mean age 15.7 years) attended the new epilepsy clinic between February 2017 and December 2017. Adolescents felt significantly better informed following education in relation to epilepsy and driving, alcohol/street drugs and birth control/pregnancy. There was no significant improvement in self-reported medication adherence, transition readiness or mental well-being at follow-up. While MH education was ranked highly in terms of importance by adolescents and parents at baseline, attendance at MH education and engagement with MH support was low. CONCLUSIONS: This paper documents what is important to young people with epilepsy regarding service delivery. The new adolescent service was well received. Based on feedback from adolescents and parents relating to the service, and the suboptimal uptake of MH supports, the model of care has been revised to reduce attendance burden on families and improve patient experience.

Attempted Suicide, Self-Harm, and Psychological Disorder Among Young Offenders in Custody.

This study aims to identify risk factors for suicide and self-harm among young offenders. The data are from the 2009 New South Wales Young People in Custody Health Survey. The sample (N = 313) were 88% male and 48% Aboriginal. Sixteen percent reported ever having suicidal thoughts and 10% reported a suicide attempt. Twenty-one percent reported thoughts of self-harm and 16% reported actual self-harm. Female young offenders reported higher rates of suicidal behavior and self-harm compared to males. Significant correlates of attempted suicide and self-harm included childhood adversity and psychiatric disorder. This study finds that young offenders are at high risk of suicidal and self-harm behaviors. Early identification and support among this vulnerable group are critical.

Assessing the risk of imminent aggression in mentally ill young offenders.

OBJECTIVES: Aggression in adolescents presents a significant problem for psychiatric units. The Dynamic Appraisal of Situational Aggression (DASA) is an empirically validated measure designed to appraise the risk of imminent aggression (within the next 24 hours) in adult patients. Our aim was to examine the predictive validity of the DASA: Youth Version (DASA:YV) with youth-specific items, in young offenders hospitalised with a mental illness. METHODS: This prospective validation study involved 4440 DASA:YV ratings of mentally ill adolescents in a secure hospital. At 24 hours post-assessment, the nursing staff documented whether patients had behaved aggressively: physically, verbally or towards property. Predictive accuracy was assessed using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. RESULTS: The DASA:YV significantly predicted any imminent aggression (AUC = 0.754). Additional youth-specific items conferred a greater predictive yield, as compared to adult-derived items (p = 0.014). CONCLUSIONS: It is possible to monitor the risk state of hospitalised mentally ill youth, so that heightened states can be detected early, thus facilitating interventions to reduce the risk of violence.

Childhood maltreatment and post-traumatic stress disorder among incarcerated young offenders.

Young offenders have a high prevalence of mental illness and a large proportion report experiencing a number of traumatic events during childhood, but there is little research exploring this association. This study describes the prevalence of, and association between, child maltreatment and post-traumatic stress disorder (PTSD) among young offenders. The study uses data collected as part of the 2009 NSW Young People in Custody Health Survey which was conducted in nine juvenile detention centers. This paper reports on findings from the baseline questionnaires and 18-months of re-offending data. The analysis included 291 participants who were assessed for PTSD and child maltreatment. The sample was 88% male, 48% Aboriginal, with an average age of 17 years (range 13-21 years). One in five (20%) participants were diagnosed with PTSD, with females significantly more likely to have PTSD than males (40% vs. 17%, p<0.05). Over half (60%) of young offenders reported any child abuse or neglect, with females nearly 10 times more likely to report three or more kinds of severe child maltreatment than males. The main correlate for a diagnosis of PTSD was having three or more kinds of severe child maltreatment (OR=6.73, 95% CI: 1.06-42.92). This study provides evidence for the need to comprehensively assess child abuse and neglect among young offenders in order to provide appropriate treatment in custody and post-release.

The use of xenobiotic-mediated methaemoglobin formation to assess the effects of thyroid hormones on diabetic and non-diabetic human erythrocytic oxidant defence mechanisms in vitro.

Diabetes is associated with an abnormal incidence of hypothyroidism, which exacerbates hyperglycaemia, so further damaging already compromised erythrocytic defence mechanisms. Methaemoglobin formation is a useful measure of the health of these mechanisms, as it determines the resistance of diabetic erythrocytes to sustained oxidative stress. The effect of l-tri-iodothyronine (T(3)) was, therefore, studied on nitrite and monoacetyldapsone hydroxylamine (MADDS-NHOH) mediated methaemoglobin formation in diabetic and non-diabetic human erythrocytes. Diabetic erythrocytes showed less sensitivity compared with non-diabetics to methaemoglobin formation mediated by both compounds. A 30 min pre-incubation with T(3) at 3 and 30 nM did not affect nitrite-mediated methaemoglobin formation compared with control observations in both cell types. In diabetic erythrocytes incubated with T(3) at 30 nM, there were significant increases in MADDS-NHOH-mediated methaemoglobin formation compared with control in both diabetic and non-diabetic cells. Studies comparing blood isolated from diabetic patients stabilised on thyroxine (T(4); 50 µG/day), T(4)-free diabetics and non-diabetics, showed that T(4) supplementation significantly increased MADDS-NHOH-mediated methaemoglobin formation compared with T(4)-free diabetic cells so that for two time points, T(4)-treated diabetic erythrocytic methaemoglobin formation was indistinguishable from that of non-diabetics. These studies indicate that T(4) supplementation improves some erythrocytic oxidant defence mechanisms in a time dependent manner.