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IntroductionMental health problems are common globally, and typically have their onset in adolescence and early adulthood—making youth (aged 11–25) an optimal target for prevention and early intervention efforts. While increasing numbers of youth mental health (YMH) initiatives are now underway, thus far few have been subject to economic evaluations. Here we describe an approach to determining the return on investment of YMH service transformation via the pan-Canadian ACCESS Open Minds (AOM) project, for which a key focus is on improving access to mental health care and reducing unmet need in community settings.ApproachAs a complex intervention package, it is hoped that the AOM transformation will: (i) enable early intervention through accessible, community-based services; (ii) shift care away toward these primary/community settings and away from acute hospital and emergency services; and (iii) offset at least some of the increased costs of primary care/community-based mental health services with reductions in the volume of more resource-intensive acute, emergency, hospital or specialist services utilized. Co-designed with three diverse sites that represent different Canadian contexts, a return on investment analysis will (separately at each site) compare the costs generated by the intervention, including volumes and expenditures associated with the AOM service transformation and any contemporaneous changes in acute, emergency, hospital or service utilization (vs. historical or parallel comparators). Available data from health system partners are being mobilized to assess these hypotheses.Anticipated resultsAcross urban, semi-urban and Indigenous sites, the additional costs of the AOM transformation and its implementation in community settings are expected to be at least partially offset by a reduction in the need for acute, emergency, hospital or specialist care.DiscussionComplex interventions such as AOM aim to shift care “upstream”: away from acute, emergency, hospital and specialist services and toward community-based programming which is more easily accessible, often more appropriate for early-stage presentations, and more resource-efficient. Carrying out economic evaluations of such interventions is challenging given the constraints of available data and health system organization. Nonetheless, such analyses can advance knowledge, strengthen stakeholder engagement, and further implementation of this public health priority.

Supplemental material, sj-docx-3-cpa-10.1177_07067437231167387 for Heterogeneity in the Course of Suicidal Ideation and its Relation to Suicide Attempts in First-Episode Psychosis: A 5-Year Prospective Study by Roxanne Sicotte and Srividya N. Iyer, Éric Lacourse, Jean R. Séguin, Amal Abdel-Baki in The Canadian Journal of Psychiatry

Supplemental material, sj-docx-4-cpa-10.1177_07067437231167387 for Heterogeneity in the Course of Suicidal Ideation and its Relation to Suicide Attempts in First-Episode Psychosis: A 5-Year Prospective Study by Roxanne Sicotte and Srividya N. Iyer, Éric Lacourse, Jean R. Séguin, Amal Abdel-Baki in The Canadian Journal of Psychiatry

Supplemental material, sj-docx-1-tps-10.1177_13634615231167067 for Engaging with care in an early intervention for psychosis program: The role of language, communication, and culture by Anika Maraj, Manuela Ferrari, Kathleen MacDonald, Matthew Peters, Ridha Joober, Jai L. Shah, and Srividya N. Iyer in Transcultural Psychiatry

Supplemental material, sj-docx-1-cpa-10.1177_07067437231167387 for Heterogeneity in the Course of Suicidal Ideation and its Relation to Suicide Attempts in First-Episode Psychosis: A 5-Year Prospective Study by Roxanne Sicotte and Srividya N. Iyer, Éric Lacourse, Jean R. Séguin, Amal Abdel-Baki in The Canadian Journal of Psychiatry

Supplemental material, sj-docx-3-cpa-10.1177_07067437231167387 for Heterogeneity in the Course of Suicidal Ideation and its Relation to Suicide Attempts in First-Episode Psychosis: A 5-Year Prospective Study by Roxanne Sicotte and Srividya N. Iyer, Éric Lacourse, Jean R. Séguin, Amal Abdel-Baki in The Canadian Journal of Psychiatry

Supplemental material, sj-docx-4-cpa-10.1177_07067437231167387 for Heterogeneity in the Course of Suicidal Ideation and its Relation to Suicide Attempts in First-Episode Psychosis: A 5-Year Prospective Study by Roxanne Sicotte and Srividya N. Iyer, Éric Lacourse, Jean R. Séguin, Amal Abdel-Baki in The Canadian Journal of Psychiatry

Supplemental material, sj-docx-1-cpa-10.1177_07067437231153796 for Context and Expectations Matter: Social, Recreational, and Independent Functioning among Youth with Psychosis in Chennai, India and Montreal, Canada by Srividya N. Iyer, Thara Rangaswamy, Sally Mustafa, Nicole Pawliuk, Greeshma Mohan, Ridha Joober, Norbert Schmitz, Howard Margolese, Ramachandran Padmavati and Ashok Malla in The Canadian Journal of Psychiatry

Supplemental material, sj-docx-2-cpa-10.1177_07067437231167387 for Heterogeneity in the Course of Suicidal Ideation and its Relation to Suicide Attempts in First-Episode Psychosis: A 5-Year Prospective Study by Roxanne Sicotte and Srividya N. Iyer, Éric Lacourse, Jean R. Séguin, Amal Abdel-Baki in The Canadian Journal of Psychiatry

Supplemental material, sj-docx-2-cpa-10.1177_07067437231167387 for Heterogeneity in the Course of Suicidal Ideation and its Relation to Suicide Attempts in First-Episode Psychosis: A 5-Year Prospective Study by Roxanne Sicotte and Srividya N. Iyer, Éric Lacourse, Jean R. Séguin, Amal Abdel-Baki in The Canadian Journal of Psychiatry

Additional file 2. Table: ICC values after excluding data of Chennai participants with very divergent Time 1 and Time 2 scores on the WRS.

Additional file 1. Comparisons of responsibility assigned to stakeholder pairs by type of support.

Additional file 2. Post-hoc tests for significant differences between raters (refer to additional file 1).

Additional file 1. Whose Responsibility Scale, patient version.

Additional file 3. Post-hoc tests for significant differences between support needs in Montreal and Chennai (refer to Fig. 3).

In Canada, little research has focused on emergency department (ED) use by youth involved with child welfare services, a vulnerable population. Our aims were therefore (1) to examine the characteristics of ED users among child welfare-involved youth, 2) to identify predictors of ED use and 3) to identify youth trajectories to EDs.Data were collected from child welfare charts from two agencies in Montreal, Canada. Logistic regression was conducted to determine the predictors of ED use. Latent class analysis was used to identify trajectories to the ED.The sample included 226 youth aged 11-18 years. 33% of youth visited the ED at least once for mental health problems during child welfare involvement. ED users were more likely to be youth with a history of 1) sexual abuse, 2) parental mental illness, and 3) placements outside of the home, compared to youth with no ED visits. Mental health treatment was initiated in the 30 days following an ED presentation in 24% of cases. Three trajectories were found: 1) ED contact initiated by child welfare workers for suicidal ideation/attempts, 2) ED contact initiated by police for substance use and externalized behaviours and 3) ED contact initiated by parents for suicidal ideation/attempts.Despite all youth being followed by child welfare and many already receiving mental health services, youth had high, often recurrent ED use. This highlights the need for stronger coordination between child welfare, youth mental health services and EDs.Au Canada, peu de recherche s’est penchée sur l’utilisation du service d’urgence (SU) par les jeunes impliqués dans les services d’aide à l’enfance, une population vulnérable. Nous visions donc à (1) examiner les caractéristiques des utilisateurs de SU chez les jeunes impliqués dans l’aide à l’enfance, 2) identifier les prédicteurs de l’utilisation de SU et 3) identifier les trajectoires des jeunes au SU.Les données ont été recueillies des dossiers de l’aide à l’enfance dans deux agences de Montréal, Canada. La régression logistique a été menée pour déterminer les prédicteurs de l’utilisation du SU. L’analyse de classe latente a servi à identifier les trajectoires au SU.L’échantillon comprenait 226 jeunes âgés de 11 à 18 ans, dont 33 % ont visité le SU au moins une fois pour des problèmes de santé mentale durant leur implication à l’aide à l’enfance. Les utilisateurs de SU étaient plus susceptibles d’être jeunes avec des antécédents de 1) abus sexuel, 2) maladie mentale parentale, et 3) placements hors du foyer, comparés aux jeunes sans visite au SU. Un traitement de santé mentale a été initié dans les 30 jours suivant une présentation au SU dans 24 % des cas. Trois trajectoires ont été distinguées: 1) un contact avec un SU initié par les travailleurs de l’aide à l’enfance pour des idéations/tentatives de suicide, 2) un contact avec un SU initié par la police pour utilisation de substances et comportements externalisés et 3) un contact avec un SU initié par les parents pour des idéations/tentatives de suicide.Bien que tous les jeunes aient été suivis par l’aide à l’enfance et que nombre d’entre eux aient déjà reçu des services de santé mentale, les jeunes avaient une utilisation élevée souvent récurrente du SU. Ceci met en lumière le besoin d’une coordination plus forte entre l’aide à l’enfance, les services de santé mentale pour les jeunes et les SU.

Additional file 1.

Objectifs Synthétiser les connaissances cliniques et épidémiologiques disponibles concernant les soins de santé mentale des populations migrantes, des minorités ethniques et des populations autochtones, dans le contexte de psychose débutante.Méthodes Revue de littérature narrative portant sur la psychose débutante dans ces populations et les enjeux liés à la prestation de services d’intervention précoce.Résultats Le statut de migrant est depuis longtemps considéré comme un facteur de risque important de psychose dans de nombreux contextes géographiques. Ce risque accru chez les migrants semble persister au-delà de la première génération et s’est avéré plus élevé dans toutes les populations migrantes, mais surtout pour les minorités ethniques noires et les individus migrant de pays en développement économique vers des pays développés. Des données récentes suggèrent que ce risque plus élevé est dû, du moins en partie, à l’exposition cumulative des migrants et des minorités à des adversités sociales, telles que la discrimination raciale, la marginalisation et le désavantage socioéconomique. Le racisme systémique affectant ces populations peut être source de biais diagnostique, accentuer les disparités de traitement et contribuer à la causalité de la psychose. Certains groupes de migrants et de minorités ethniques ont des délais d’accès aux soins plus longs, sont plus souvent hospitalisés involontairement, se désengagent prématurément et sont moins satisfaits du traitement. Tenir compte du contexte socioculturel est essentiel à la prestation de soins de qualité, en particulier dans une société diversifiée. En outre, la reconnaissance des relations de pouvoir qui découlent du contexte sociétal et qui façonnent les institutions et les modèles de soins est une étape clé vers la compétence et la sécurité structurelles dans les soins de santé mentale. Plusieurs stratégies ont été proposées pour rendre les services et systèmes de soins de santé mentale plus compétents sur le plan culturel et structurel : notamment le recours à des interprètes et à des médiateurs culturels, des évaluations adaptées et des services d’interventions culturelles spécialisées. Cependant, ces stratégies n’ont pas encore été adoptées à grande échelle dans le programme d’intervention précoce pour la psychose.Conclusion Les services d’intervention précoce pour la psychose devraient intégrer des interventions inclusives, structurellement compétentes et éclairées par le contexte, afin de promouvoir l’engagement et des soins centrés sur la personne. Des efforts doivent être faits pour appliquer les connaissances de la psychiatrie sociale et culturelle et adapter ses outils au domaine de l’intervention précoce dans la psychose. Les considérations socioculturelles, jusqu’à présent appliquées de manière inconsistante dans la recherche sur la psychose et la conception des services au Québec, sont particulièrement pertinentes pour la province étant donné son contexte linguistique distinct, sa diversité culturelle croissante et son effort continu pour systématiser la prestation des services d’intervention précoce à large échelle., Objectives To synthesize the available epidemiological and clinical evidence relevant to the mental health care of migrant, ethnic minority and Indigenous populations in the context of early psychosis.Methods This study provides a narrative review of the literature on psychosis in these populations, including issues related to the provision of early intervention services for psychosis.Results Migrant status has long been reported as a significant risk factor for psychosis in many geographic contexts. This increased risk among migrants seems to persist beyond the first generation and has been found to be higher in all migrant populations, but especially for black ethnic minorities and individuals migrating from economically developing countries to developed ones. Recent evidence suggests that this higher risk is at least in part due to migrants’ and minorities’ cumulative exposure to social adversities, such as racial discrimination, marginalization and socio-economic disadvantage. Systemic racism affects migrant and minority populations by creating bias in diagnostic practices and aggravating treatment disparities in addition to contributing to causation of psychosis. Furthermore, migrant and ethnic minority groups are known to seek mental healthcare after longer delays, to be more frequently forcibly hospitalized, to disengage from treatment prematurely and to be less satisfied with their treatment. The consideration of social and cultural context and factors is essential to the provision of good healthcare, especially in a culturally diverse society. Furthermore, acknowledging power relationships that stem from the societal context and shape institutions and models of care is a key step towards structural competence and safety in mental healthcare. Several strategies have been proposed to make mental healthcare services and systems more culturally and structurally competent. These include the use of interpreters and cultural brokers, tailored assessments and specialised cultural interventions. However, these strategies have yet to be adopted broadly in early intervention for psychosis.Conclusion Given its emphasis on meaningful engagement and person-centered care, early intervention should integrate inclusive, structurally competent and context-informed interventions as a priority. Efforts must be made to apply knowledge from and adapt the tools of social and cultural psychiatry to the field of early intervention in psychosis. Sociocultural considerations, hitherto inconsistently applied in psychosis research and service design in Quebec, are especially relevant to the province given its distinct linguistic context, its increasing cultural diversity, and its ongoing effort to systematize and expand the delivery of early intervention services.

Supplemental material, sj-docx-1-cpa-10.1177_07067437211044717 for Youth Perspectives on Integrated Youth Services: A Discrete Choice Conjoint Experiment by Joanna Henderson, Lisa D. Hawke, Srividya N. Iyer, Em Hayes, Karleigh Darnay, Steve Mathias and Lehana Thabane in The Canadian Journal of Psychiatry

Supplemental material, sj-docx-2-cpa-10.1177_07067437211044717 for Youth Perspectives on Integrated Youth Services: A Discrete Choice Conjoint Experiment by Joanna Henderson, Lisa D. Hawke, Srividya N. Iyer, Em Hayes, Karleigh Darnay, Steve Mathias and Lehana Thabane in The Canadian Journal of Psychiatry

Supplemental material, sj-docx-2-cpa-10.1177_07067437211044717 for Youth Perspectives on Integrated Youth Services: A Discrete Choice Conjoint Experiment by Joanna Henderson, Lisa D. Hawke, Srividya N. Iyer, Em Hayes, Karleigh Darnay, Steve Mathias and Lehana Thabane in The Canadian Journal of Psychiatry

Introduction : les programmes d’intervention précoce en premiers épisodes psychotiques (PIPÉP) constituent un modèle qui améliore l’évolution des individus souffrant de psychose débutante. Au Québec, après 30 ans de développement mené par les cliniciens, le ministère de la Santé et des Services sociaux a annoncé des mesures structurantes pour soutenir l’implantation de PIPÉP à travers la province en 2017. Objectifs : 1) Décrire le degré d’implantation des PIPÉP au Québec et leur profil d’adhésion aux composantes essentielles du modèle en 2020. 2) Décrire les différences entre les PIPÉP implantés avant et après 2017. Méthode : étude descriptive longitudinale de l’évolution des PIPÉP au Québec menée par sondage électronique en 2016 et en 2020. Résultats : - En 2020, 28 des 33 PIPÉP existants ont répondu au sondage, dont 11 implantés après 2017. - En 2016, 17 des 18 PIPÉP existants ont répondu. Des critères d’admission inclusifs, des cibles de délais maximaux et processus directs de référence favorisent l’accessibilité aux PIPÉP. Des interventions biopsychosociales variées démontrées efficaces (p. ex. : interventions familiales) sont offertes par des équipes interdisciplinaires. Le respect des ratios de patients: case manager, la collecte de données clinico-administratives et l’emploi d’outils de mesures cliniques standardisés demeurent des défis. Des différences ont été relevées entre les programmes fondés avant et après 2017, notamment en regard de la diversité d’interventions psychosociales offertes et de l’adhésion aux standards d’accessibilité. Conclusion : l’implantation rapide de PIPÉP fidèles au modèle est possible en présence de soutien gouvernemental et de la détermination des professionnels qui y œuvrent. Les PIPÉP québécois offrent des services de qualité, mais des lacunes existent en regard des composantes organisationnelles., Introduction: Early intervention for psychosis is a service delivery model that has been shown to improve outcomes for first-episode psychosis. This model is premised on adherence to essential components. In Quebec, after 30 years of clinician-led development, the Ministry of Health and Social Services announced several measures to support the implementation of early intervention services for psychosis (EIS) across the province in 2017. Objectives: 1) To describe the state of implementation of EIS in Quebec in 2020 and their adherence to essential components of the EIS model. 2) To describe differences between programs implemented before and after 2017. Methods: A descriptive longitudinal study on EIS implementation in Quebec, involving two online surveys conducted in 2016 and 2020. Results: In 2020, 28 of the 33 existing EIS responded to the survey, including 11 which were implemented after 2017. In 2016, 17 of the 18 EIS in operation had completed the survey. Inclusive admission criteria, maximum delay targets, and open referral policies are being followed to promote easy and rapid access to EIS. A variety of effective biopsychosocial interventions (e.g., family interventions) are offered by interdisciplinary teams. Reported challenges include difficulty maintaining patient-to-case manager ratios and use of clinical/administrative databases and standardised clinical tools. There were some differences between programs founded before and after 2017, notably regarding the diversity of psychosocial interventions that are offered and adherence to accessibility standards. Conclusion: Rapid implementation of EIS that adequately adhere to the model’s essential components is possible, with increased government support and determined clinicians. EIS in Quebec provide quality services to patients, but there are shortcomings with respect to administrative and organisational components.

Contexte: Les problèmes de santé mentale émergent majoritairement chez les adolescents et jeunes adultes. Les jeunes en situation d’itinérance (JSI) ont d’importants besoins non-comblés en lien avec leur santé mentale et ce possiblement davantage pour les jeunes de minorités linguistiques (JML). Objectifs: Décrire les facteurs associés aux expériences d’accès aux services de santé mentale chez les JSI, en comparant les expériences des jeunes de majorité linguistique (francophones) aux JML (anglophones et allophones). Méthodes: 22 jeunes de 18 à 25 ans ont participé à la cartographie communautaire, méthode de recherche qualitative utilisant les arts, où les participants ont créé leurs cartes des ressources d’aide en santé mentale. Des groupes de discussion ont permis aux jeunes d’exprimer leurs perceptions de l’accès et des services. Les résultats sont générés par une analyse thématique. Résultats: Les facteurs liés aux expériences d’accès aux services se regroupent en deux catégories: (1) des soins adaptés à l’individu, et (2) la disponibilité et la structure des services. Les JSI veulent des services adaptés aux besoins spécifiques des JSI et des minorités (incluant les JML), avec une approche centrée sur les besoins de l’individu. Les JML identifient moins de diversité de services et se tournent vers des stratégies alternatives de soins ou des services itinérance adulte. Conclusion: Des services co-localisés et intégrés, répondant aux besoins de base et de santé mentale, permettraient de diminuer les obstacles à l’accès aux soins pour les JSI. Une attention particulière aux JML est nécessaire puisqu’ils rencontrent davantage d’obstacles que leurs pairs JSI., Background: Most mental illnesses begin in youth. The homeless youth population reports a high level of unmet mental health needs; a situation which is possibly worse for linguistic minority homeless youths. Objectives: To describe the factors associated with homeless youths’ experiences of accessing mental health services and to highlight differences in such experiences between linguistic majority (Francophones) and linguistic minority (Anglophones and Allophones) groups. Methods: 22 youths between 18 to 25 years old participated in community mapping, an arts-based qualitative research method in which participants draw maps of resources they use to receive help with their mental health. Discussion groups enabled youths to express their emotions and perceptions towards access and services. Thematic analysis was user on verbal and visual data. Results: Factors associated with of access to mental health services were grouped into two categories: (1) care adapted at the individual level, and (2) availability and structure of services. Homeless youths need services that are adapted to the specific needs of homeless youths and minorities (including linguistic minorities), with an approach to care centered on an individual’s needs. Linguistic minority homeless youths identify less diversity in services and often turn to informal mental health strategies or to adult-oriented homeless services. Conclusion: Services that are co-located and integrated with mental health and basic needs services help bypass a lot of identified barriers to care for homeless youths. Particular attention needs to be paid to linguistic minority homeless youths as they experience more barriers than their counterparts.