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Aim: A range of residential supports is available for young people experiencing mental health challenges. One Australian example is the Youth Residential Rehabilitation Service, which provides up to 12 months of intensive psychosocial support in a residential setting to young people aged 16-25 experiencing serious mental health challenges. This paper aimed to add to the scant literature on these services, describing the experiences of young people and staff members across the duration of a stay., Methods: This study drew on collaborative autoethnography to engage and centre the direct lived experience of young people who had lived, and staff who had worked, in a Youth Residential Rehabilitation Service., Results: We identified three phases that young people typically journey through during their stay at the service. The Arriving phase was marked by appropriate referrals, a warm welcome, a period of settling in and the development of trusting relationships. The Discovering phase saw young people identifying and enacting their strengths, hopes and values. Community connections were a focus of the Continuing phase as lives after service exit were envisioned and created., Conclusions: Drawing on collaborative autoethnography methods represents one approach to amplify the voice of young people in service design and evaluation. This paper richly described some of the possibilities and complexities of the Youth Residential Rehabilitation Service experience, which can be used to inform the service's pacing and structure of support., (© 2021 John Wiley & Sons Australia, Ltd.)

Background: Mental health problems frequently occur during adolescence, however, few adolescents seek treatment for these problems, especially for eating disorders. The current study aimed to quantify how adolescents in a clinical sample (ie, those receiving treatment for an eating disorder), differ in terms of psychological factors (eating disorder symptoms and psychological distress), compared to adolescents with eating pathology in a community sample (ie, those not receiving treatment)., Method: Data were used from a community sample of adolescents with eating disorder pathology who have not sought treatment (n = 1011) and a clinical sample of adolescents presenting at eating disorder services for treatment (n = 153). Participants reported demographics and completed questionnaires assessing weight/shape concerns, disordered eating and psychological distress., Results: Adolescents with a lower BMI, more frequent purging and higher weight/shape concerns were more common in the clinical sample, while those engaging in more frequent driven exercise were less common in the clinical sample. The samples did not differ in severity of psychological distress., Conclusions: The findings highlight the need for increasing mental health literacy about the role of BMI and driven exercise in eating disorder symptom presentation to increase early detection of these disorders among adolescents., (© 2020 John Wiley & Sons Australia, Ltd.)

Decades of reports and policy have drawn attention to the significant social and occupational impairment of many young Aboriginal men in Central Australia. However, the role of mental ill-health as a contributing factor to this impairment, and culturally appropriate intervention targets have received insufficient attention in the psychiatry literature. Despite having the worst health outcomes of any population in Australia, Aboriginal men chronically underuse primary health care services. It's proposed that interventions ensuring cultural continuity through Identity-strengthening with a particular focus on positive Aboriginal masculinities will address a critical mental health gap for young men. In Central Australian and broader Indigenous populations, tangible and measurable kinship, language, religious and economic (KLRE) activities are catalytic vehicles for restoring traditional knowledge that suffer ongoing pressures as a result of colonization and assimilationist Government policy. By transforming KLRE knowledge content from ethnographic archives, these culturally rich repositories may be utilized to create education and engagement materials that will support young Aboriginal men's efforts to obtain and maintain positive mental health. This proposal focuses on building resilience through the acquisition of KLRE knowledge which young Aboriginal men can utilize as resources for enhancing positive identity and mental health outcomes., (© 2021 John Wiley & Sons Australia, Ltd.)

Aim: Late teens and early adulthood is the peak age of onset for mental disorders. Currently, there is a gap between primary mental health care and more intensive mental health services for young people in New South Wales (NSW), Australia. Two headspace Early Intervention Teams (hEITs) were developed to bridge this gap in Sydney Local Health District (SLHD), in Sydney, Australia. This study aims to explore clinician experiences of hEIT after the first 2 years of implementation., Methods: Semistructured interviews were conducted with key clinicians working within hEIT or closely associated with hEIT. Nine interviews were conducted, transcribed and analysed using qualitative thematic analysis., Results: Four themes were identified: (1) building a bridge between services, (2) filling a clinical gap, (3) service collaborations and their challenges and (4) difficulties of small team size., Conclusions: There is evidence that clinicians value the service provided by hEIT. There are difficulties such as referral confusion, staff turnover and suggestions to increase staffing to improve the stability, skill diversity and viability of the service. Findings have implications for other collaborative youth mental health models., (© 2021 John Wiley & Sons Australia, Ltd.)

Aim: Up to half of patients with borderline personality disorder report auditory verbal hallucinations that are phenomenologically indistinguishable from those in schizophrenia, occur early in the course of the disorder, and are enduring, distressing and disabling. In clinical practice, this symptom is widely assumed to be unresponsive to treatment with antipsychotic medication and early intervention is rarely offered. The Verbal Experiences Response in Borderline personality disorder to Aripiprazole TrIal Medication (VERBATIM) study aims to be the first controlled trial to investigate the effectiveness of conventional pharmacotherapy for this symptom in this patient group., Method: VERBATIM is a 12-week, triple-blind, single-centre, parallel groups randomised controlled trial, with a 27-week follow-up period. Participants between the ages of 15 and 25 years receive either aripiprazole or placebo daily, commencing at 2 mg and increasing to 10 mg by day 15. Further dose escalations (up to 30 mg) may occur, as clinically indicated. This trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry ACTRN12616001192471 on 30/08/2016., Results: The primary outcome is severity of auditory verbal hallucinations assessed using the Psychotic Symptom Rating Scale. Secondary outcomes include the severity of general psychopathology, borderline personality pathology, social and occupational functioning and change in brain resting state connectivity. The primary endpoint is week 12 and secondary endpoint is week 39., Conclusion: The results will inform treatment decisions for individuals with borderline personality disorder who present with auditory verbal hallucinations., (© 2019 John Wiley & Sons Australia, Ltd.)

Aim: The provision and implementation of early intervention for psychosis services (early intervention services [EIS]) has received increasing attention over recent years. Maximizing engagement with EIS is of clinical and economic importance, and exploring the experiences of those who access EIS is vital. Although research has been conducted exploring the experiences of engaging with EIS from both a service user and carer/family member point of view, these data have not been systematically collated to generate new understanding. The primary aim of this study is to review, critically appraise and synthesize qualitative findings relating to the experiences of service users and/or carers and family members engaging with EIS., Methods: Four databases were systematically searched. Studies were analysed using an inductive thematic analysis approach, within a critical realist epistemological framework. Studies were critically appraised using the critical appraisal skills programme tool., Results: Fourteen papers were identified for inclusion. Three main themes were identified: the importance of a personal relationship with an EIS staff member, the impact of this relationship and consideration of life after EIS. The importance of a strong relationship with EIS staff was the most prominent theme throughout the papers reviewed., Conclusions: The quality of the therapeutic relationship with at least one EIS staff member was the single most important factor in determining whether the experience of accessing EIS was a positive or negative one. The majority of the studies reviewed were conducted in the United Kingdom or Australia. Therefore, more research across countries is needed to understand transferability of findings., (© 2019 John Wiley & Sons Australia, Ltd.)

Aim: headspace is Australia's innovation in youth mental healthcare and comprises the largest national network of enhanced primary care, youth mental health centres world-wide. headspace centres aim to intervene early in the development of mental ill-health for young people aged 12 to 25 years by breaking down the barriers to service access experienced by adolescents and emerging adults and providing holistic healthcare. Centres have been progressively implemented over the past 12 years and are expected to apply a consistent model of integrated youth healthcare. Internationally, several countries are implementing related approaches, but the specific elements of such models have not been well described in the literature., Method: This paper addresses this gap by providing a detailed overview of the 16 core components of the headspace centre model., Results: The needs of young people and their families are the main drivers of the headspace model, which has 10 service components (youth participation, family and friends participation, community awareness, enhanced access, early intervention, appropriate care, evidence-informed practice, four core streams, service integration, supported transitions) and six enabling components (national network, Lead Agency governance, Consortia, multidisciplinary workforce, blended funding, monitoring and evaluation)., Conclusion: Through implementation of these core components headspace aims to provide easy access to one-stop, youth-friendly mental health, physical and sexual health, alcohol and other drug, and vocational services for young people across Australia., (© 2018 The Authors Early Intervention in Psychiatry Published by John Wiley & Sons Australia, Ltd.)

Aim: Almost a quarter of young Australians experience a mental health issue that may become chronic if left untreated. Children and Young People's Mental Health (CYPMH) is a specialist tertiary service for young people with moderate to severe mental health problems on the Central Coast in Australia. This paper presents an overview of client data and service use collected over a 1 year period specific to the Youth Mental Health (YMH) component of the service., Method: Client data, including demographic characteristics, service usage, presenting issues and standardized outcome measures, were analysed using SPSS. Clinicians routinely collect MH-OAT (Mental Health Outcomes and Assessment Tools) measures at different points in a client's episode of care, and each of these measures was analysed separately. Wilcoxon Z and a series of McNemar's tests were used to report on the difference between admission and discharge scores., Results: During a designated 1 year period, 830 referrals to YMH were received. The most prevalent presenting issue was suicidal ideation followed by deliberate self-harm and depression. A comparison of admission and discharge outcome scores shows significant improvement by discharge on a range of measures. Specifically, analysis identified significant differences between admission and discharge HoNOSCA (Health of the Nation Outcomes Scales for Children and Adolescents) and CGAS (Children's Global Assessment Scale) scores for young people aged 12-17 and HONOS (Health of the Nation Outcomes Scale) scores for young people aged 18-24., Conclusion: The clinical outcomes for young people are positive with improvements seen on a range of measures., (© 2015 Wiley Publishing Asia Pty Ltd.)

Aim: On the basis of applying 'ultra-high-risk' (UHR) criteria, initially high rates of transition to psychosis were reported. However, a decline in transition to psychosis has been observed in recent years. The current descriptive paper aims to investigate if this drop in transition rate may be due to potential changes in patterns of referral to a large UHR clinic., Methods: One hundred fifty young people who were referred to the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne, Australia, between August 2000 and July 2004 were included. Their referral pathways were assessed using a semistructured interview. Results were compared with a similar study of a cohort referred to the same clinic between 1995 and 1996., Results: The mean number of contacts prior to referral to the PACE Clinic was 1.93 (standard deviation (SD) = 1.15), and the average time between symptom onset and referral to PACE was 46.5 weeks (SD = 57.4). In comparison with the earlier cohort (mean = 2.36; SD = 1.32), our results indicate a lower number of contacts (Cohen's d = 0.35, r = 0.17). Furthermore, participants in the current study were referred twice as fast to the PACE Clinic., Conclusions: Increasing awareness of UHR symptoms among professionals and in the general population seems to have resulted in faster referral of young people to specialized mental health services. The global drop in transition rate might be due to a change in referral pathways to UHR services., (© 2013 Wiley Publishing Asia Pty Ltd.)

Aim: headspace centres comprise a significant innovation in community-based youth mental health service delivery in Australia. This paper examines the service activity of the first headspace centres to determine common and unique practice characteristics across headspace centres in this new approach to mental health service delivery., Methods: Data come from quarterly progress reports provided by the first 30 headspace centres during the 2010-2011 financial year. The information from 120 reports was analysed qualitatively using thematic analysis techniques to determine the types of activities reported by centres against key performance indicators., Results: The main finding was the large number and wide range of centre activity. This heterogeneity may be explained in part by the diversity of communities across Australia and the importance that headspace places on addressing the specific needs of the local community as well as drawing upon the existing capacity that is available within a community. The most common activities were community engagement, building local partnerships and providing a youth friendly environment. There was a particularly strong focus by the majority of centres on establishing and supporting a Youth Reference Group to guide centre development and implementation., Conclusions: The progressive upscaling of headspace centres across Australia provides a unique opportunity to observe how a significant reorientation in health service delivery is implemented in practice to meet the needs of diverse communities. Further investigation of the headspace experience will provide critical lessons for other countries investing in new approaches to youth mental health., (© 2013 Wiley Publishing Asia Pty Ltd.)

Aim: Consumer participation is increasingly being understood in both a policy and a practice context as an essential component of mental health service planning, delivery and evaluation. Existing models of participation benefit from adaptation to suit the early intervention context., Methods: This paper describes a unique programme of 'youth' consumer participation occurring at Orygen Youth Health (OYH)--an early intervention service in Melbourne, Australia. Flexibility and support are key components of the model. As well as supporting increased consumer-centredness of service delivery, the model aims to support the recovery of those involved in participation activities., Results: The programme described is comprehensive, multimodal, continues to evolve and is successful based on anecdotal feedback. However, there are no evaluation data to support its attainment of outcomes., Conclusion: Consumer participation is an essential part of mental health service development, delivery and evaluation and must be incorporated into early intervention services. As programmes of participation evolve, comprehensive models of evaluation must be developed to acknowledge their outcomes., (© 2011 Blackwell Publishing Asia Pty Ltd.)

Aim: This paper considers the priorities for policy to promote youth mental health in Australia. The Ottawa Charter is applied as a conceptual framework to determine current strengths and future priorities across the entire spectrum of interventions for mental health promotion., Methods: The five platforms of the Ottawa Charter are used to categorize some of the major initiatives that promote youth mental health. Areas of strength and major gaps within each platform are identified., Results: Australia was shown to be at the forefront of many youth mental health promotion initiatives, particularly in the service reorientation and personal skills platforms of the Ottawa Charter., Conclusions: While significant progress has been made in some areas of youth mental health promotion, areas of critical need for policy focus were: oversight of all public policies for their impact on youth mental health; more supportive environments for youth and better interconnection with mental health care; community action to support the youth voice; investment in resources for parents and families; ensuring quality inreach and outreach to provide young people with positive mental health messages and improve mental health literacy; and embedding and expanding effective innovations in youth mental health services reorientation., (© 2011 Blackwell Publishing Asia Pty Ltd.)

Aim: The Mission Australia annual National Survey of Young Australians aims to generate insights into what young people think on a range of issues, including what they value, what issues are of concern to them, and where they go for advice and support., Methods: A two-page opt-in questionnaire was distributed to a very broad range of organisations across Australia, and was available in both an online and paper-based format. Responses to the survey were anonymous. Respondents were asked to rank items from the lists provided, and results are reported on the basis of items ranked one, two or three by respondents. Responses were disaggregated by age, gender, cultural background and living arrangements., Results: Close to 48,000 young people participated in the 2009 survey, and the data confirms the importance of relationships to young people, as well as the diversity of concerns they may have, including drugs, suicide, mental health and body image. While concerns tended to vary with age and to some extent gender, what is valued by young people tends to be consistent across age and genders, namely family and friends., Conclusions: Implications for policy making and service delivery are drawn with a focus on the issues of relationships, drugs and mental health. In particular, the need for early intervention, evidence-based drug education programs, and initiatives that support those closest to young people, to assist them when they have concerns, are highlighted., (© 2011 Blackwell Publishing Asia Pty Ltd.)