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Aim: Research has shown that experiences of psychosis can have a significant impact on an individual's identity. Moreover, the way those who experience psychosis make sense of these changes appears to affect their recovery journey and hold clinical significance. However, this area of research is still very much developing, and there is a need for reviews, which look to synthesise and understand this process of identity change to guide clinicians working in this area as well as future research. This study looks to meet that gap and aims to synthesise qualitative literature exploring the lived experience of identity change amongst people who experience psychosis. Methods: A systematic review using thematic synthesis was carried out. The PRISMA and ENTREQ guidelines were followed in reporting the study. Results: Ninety‐one papers were identified which met criteria for inclusion and 31 papers included in the synthesis at which point conceptual saturation was judged to have been reached. Five themes were created: psychosis as an obliteration of the old self; the futile fight against psychosis; mourning for who I was; the battle for self as a battle against disempowerment; and recovery as rebirth. Conclusions: Results highlighted the substantive impact an experience of psychosis has on an individual's identity, the key role sense making around these identity changes plays in recovery and the crucial impact of clinicians on the sense‐making process. The implications for theory, future research and clinical practice are discussed. [ABSTRACT FROM AUTHOR]

PAPER: Longitudinal risk of psychosis in adolescent psychiatric inpatients: A Scottish popula... I Liana Romaniuk, Centre for Clinical Brain Sciences (CCBS), University of Edinburgh, UK i I Ian Kelleher, Centre for Clinical Brain Sciences (CCBS), University of Edinburgh, UK i B Background: b Current approaches to identifying individuals at high risk of developing psychosis capture only a small minority of the total population who will ultimately develop psychosis. PAPER: Moving beyond psychosis transition: Stressing functioning as a key outcome in UHR rese... I Louise Birkedal Glenthøj, Mental Health Centre Copenhagen, University of Copenhagen i I Tina Dam Kristensen, Copenhagen Research Centre On Mental Health, University of Copenhagen, Denmark i I Christina Wenneberg, Copenhagen Research Centre On Mental Health, University of Copenhagen, Denmark i I Lise Mariegaard, Copenhagen Research Centre On Mental Health, University of Copenhagen, Denmark i I Merete Nordentoft, Copenhagen Research Centre On Mental Health, University of Copenhagen, Denmark i Expanding research into the UHR state has recognized that the UHR status confers a clinical risk beyond conversion to psychosis; that is the risk of poor functional outcome irrespective of psychosis development. Almost three decades of research on subjects with an "at risk mental state" (ARMS) have revealed few basic facts: (1) about 1 out of 3 young help-seekers with ARMS transition to psychosis at 10-11 years; (2) transition to psychosis prevalence in adolescence are commensurable to those found in adult samples, hence legitimating the rational for transitional age mental health; (3) clinical outcomes other than psychosis (e.g., suicide, self-harms, exit-syndromes other than psychosis, declining functional adaptation) are heterogeneous in both adult and adolescent ARMS, yet they are proportionally more severe than in non-ARMS help-seekers. [Extracted from the article]

Aim Methods Results Discussion Conclusion The aim of this paper is to present 25 years of clinical experience with family psychoeducation (FPE) work at Stavanger University Hospital in Norway, highlighting the lessons learned in overcoming implementation barriers in publicly funded specialized mental health care.This retrospective analysis reviews the integration and sustainability of FPE work within the hospital's standard treatment protocols for psychosis, tracing its origins from the Early Treatment and Intervention in Psychosis (TIPS) study (1997–2000) to its current application. The paper examines key strategies for successful implementation, including staff training and resource allocation, as emphasized by international research.Stavanger University Hospital has successfully implemented and maintained both multi‐ and single‐family FPE approaches over the past 25 years. Initially part of the TIPS study, FPE has been integrated into routine clinical practice for treating psychosis and has recently been extended to families of patients with other severe mental disorders. The sustained success at Stavanger University Hospital is attributed to consistent staff training and the prioritization of sufficient resource allocation.The successful and sustainable integration of FPE at Stavanger University Hospital is relatively unique. International guidelines recommend FPE for psychosis, but its implementation remains inconsistent globally, despite over 50 years of supporting evidence. The hospital's experience underscores the critical role of continuous training and dedicated resources in embedding FPE into regular clinical practice. These findings suggest that addressing these areas can significantly enhance the uptake of FPE in other clinical settings.The 25‐year experience at Stavanger University Hospital demonstrates that with appropriate training and resources, FPE can be successfully integrated and sustained within standard mental health care practices. This case study provides valuable insights for other institutions aiming to implement FPE and improve treatment outcomes for patients with severe mental disorders. [ABSTRACT FROM AUTHOR]

Aim: Access to timely treatment is key to early intervention in psychosis. Despite this, barriers to treatment exist. In this review, we aimed to understand the structural barriers that patients and caregivers face in help‐seeking for first‐episode psychosis, and the recommendations provided to address these. Methods: We conducted a systematic review (PROSPERO: CRD42021274609) of qualitative studies reporting structural barriers to help‐seeking from the patient or caregiver perspective. Searches were performed in September 2023, restricted to studies published from 2001. Study quality was appraised using Critical Appraisal Skills Programme. Data were analysed using thematic synthesis. Results: Nineteen papers from 11 countries were included. Across all papers, participants reported experiencing structural barriers to receiving healthcare. For many patients and caregivers, the process of accessing healthcare is complex. Access requires knowledge and resources from parents, caregivers and healthcare providers, yet too often there is a misalignment between patients' needs and service resources. Expertise amongst healthcare providers vary and some patients and caregivers experience negative encounters in healthcare. Patients highlighted earlier caregiver involvement and greater peer support as potential routes for improvement. Conclusion: Patients and caregivers face multiple structural barriers, with legislative practices that discourage family involvement, and healthcare and transport costs found to be particularly problematic. Understanding these barriers can facilitate the co‐design of both new and existing services to provide easier access for patients and caregivers. Further research is needed focusing not only on the perspectives of patients and caregivers who have accessed professional help but also crucially on those who have not. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: Early Intervention in Psychosis teams (EITs) are a growing entity internationally, yet they remain under‐researched given challenges facing their delivery. Model adaptations include stand‐alone services, a hub‐and‐spoke model with various bases and integrating specialist staff into existing mental health teams. The present critical review focuses on reviewing the evidence base for the delivery of EITs in rural areas, first pertaining to evidence for model adherence and second to clinically outcomes. Method: A systematic literature search was undertaken, finding 53 papers of interest. Nine papers met the inclusion criteria. A critical appraisal tool was used to consider the quality of the evidence and a narrative review of their findings is presented. Results: The five studies reporting clinical outcomes of rural EITs demonstrate positive outcomes of a hub‐and‐spoke and stand‐alone EIT on reducing hospital admissions, psychotic symptoms and improving quality of life. One study directly comparing hub‐and‐spoke to stand‐alone EIT found that hub‐and‐spoke EIT had more positive outcomes than a stand‐alone service. Of the studies attempting to promote adherence to EIT model in rural areas, services show low overall adherence and report issues pertaining to funding and managerial support for practical barriers to implementation. Conclusions: EIT services in rural areas may show similar positive outcomes to urban areas and adaptations to suit rural populations appear acceptable, such as using a hub‐and‐spoke model, though further research is required. Adherence to EIT service models in rural areas may be limited and training programmes to promote adherence benefit from managerial and financial support. [ABSTRACT FROM AUTHOR]

Aim: The COVID‐19 pandemic has presented significant challenges for young people and youth mental health services. To address a gap in knowledge about the impact of the pandemic and associated restrictions on youth mental health services, this paper examined the nature of young people's engagement with Jigsaw's brief intervention service during the pandemic. Method: Data gathered from young people engaging with Jigsaw's brief intervention service in the 12 months after the official declaration of the COVID‐19 pandemic (n = 6161), and 12 months prior (n = 8665) were examined. Results: There were less referrals to Jigsaw during the pandemic, especially during lockdown periods, but this rebounded when public health restrictions were eased. A higher proportion of females (p <.001) and 12–17 year olds (p <.001) were referred during the pandemic period. There was an increase in the proportion of young people who presented with anxiety (p <.001) and sleep changes (p <.001). Although 12–16 year olds reported significantly higher levels of distress during the pandemic (p <.05), the effect size was small. Young people reported high levels of satisfaction with the new phone/video modes of support offered by Jigsaw, and the overall attendance rate improved during the pandemic period. Conclusions: The impact of COVID‐19 on young people's mental health needs to be considered as a priority. This paper is helpful for services considering the long‐term mental health needs of young people, and the best way of meeting those needs. [ABSTRACT FROM AUTHOR]

Aim: There has been a global movement towards transformation of youth mental health services, but limited information on the core principles and characteristics of these new services is available. Jigsaw is one such service, established in Ireland in 2006, with the intent of creating change in Ireland's system of mental healthcare for 12–25 year olds. The aim of this paper is to describe the evolution of Jigsaw services, which are now firmly embedded in the Irish system of care for young people, and recognized internationally as an established service network. Methods: This paper describes provides an up‐to‐date description of the Jigsaw service model, key areas of evolution that have shaped this model, and identifies future directions in service development. Results: Key attributes of the Jigsaw service model including therapeutic service, scope of practice, youth mental health promotion, youth participation, and monitoring/evaluation are described in this paper. Information on key enablers (funding and governance/quality) and service providers is also included. Conclusions: Information on the core principles and characteristics of youth mental health services is important. This paper addresses a gap in the literature by describing the Jigsaw service model, which continues to evolve so that it is responsive to the needs of young people. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aim: Family interventions are a core component of first‐episode psychosis (FEP) treatment; however, low implementation rates are consistently reported. As such, work is needed to understand the factors impacting real‐world treatment delivery. The present paper describes the implementation of the McFarlane‐model multifamily psychoeducational groups (MFG) in established FEP early intervention programs within a single state. The aims were to examine (a) training participation and implementation of MFG, (b) barriers and facilitators to implementation, and (c) modifications made to MFG. Methods: Practitioners from six established FEP early intervention programs received in‐person training and ongoing consultation in MFG. Training participation data were obtained via attendance and implementation outcomes were obtained from practitioner reports. Fifteen months following the initial training, practitioners reported on clinic‐specific barriers, facilitators, and modifications across four categories (context, intervention, practitioner, and recipient). Results: Twenty‐three practitioners across six clinics received in‐person training and were offered ongoing consultation to support implementation. Difficulties in starting MFG were salient as the earliest group was run 7 months after the initial training, thereby resulting in low overall frequency of groups. A number of barriers spanning context, intervention, practitioner, and recipient domains were noted, the majority of which were clinic‐specific. Despite challenges, practitioners identified several facilitators and made modifications to the intervention and its delivery in service of implementation. Conclusions: Results from this implementation case study highlighted the challenges of delivering MFG in real‐world FEP early intervention programs. Further, this paper emphasizes the value in identifying and addressing clinic‐specific factors when implementing MFG. [ABSTRACT FROM AUTHOR]

Aim: Evidence suggest individuals with mental disorders and psychotic experiences (PE), even transient PE, show poorer psychosocial outcomes relative to those with mental disorders. The concept of "attachment" is hypothesized as the mechanism by which people seek support in times of need. This can be measured as discrete styles or as positive (low avoidance/anxiety)/negative (high avoidance/anxiety) dimensions. Adult attachment has previously been examined on PE risk factors, but not outcomes. This study aimed to examine the relationship between transient childhood PE and adult psychosocial outcomes, comparing those with and without mental disorders. Second, to examine the role of adult attachment. Method: Participants (n = 103) attended baseline (age 11–13) and 10‐year follow‐up. PE and mental disorders were measured using the Schedule for Affective Disorders and Schizophrenia for School‐aged Children. Attachment and outcomes were measured using self‐report measures. Analysis compared those with PE (with/without mental disorders), and mental disorders without PE, to controls, using linear and Poisson regression. Results: PE was associated with lower self‐esteem (β = −2.28, p =.03), perceived social support from friends (β = −2.80, p =.01), and higher stress in platonic relationships (IRR = 1.64). PE and mental disorders were associated with lower self‐esteem (β = −5.74, p =.002), higher stress in romantic (IRR = 1.40) and platonic (IRR = 1.59) relationships, general stress (β = 5.60, p =.006), and mental distress (β = 5.67, p =.001). Mental disorders alone was not associated with any measure. Adult attachment dimensions attenuated some results. Conclusions: This paper illustrates the association between transient PE and adult psychosocial outcomes, with & without co‐occurring mental disorders, and demonstrates the role of adult attachment. [ABSTRACT FROM AUTHOR]

Aim: A substantial gap between young people's need for mental health care services and their actual access to such services led worldwide organizations (e.g., the WHO) to recommend the implementation of early intervention programs and youth mental health services. Some countries around the world have established structures to meet this recommendation. In this paper, we describe soulspace as the first integrated youth mental health service for young people aged between 15 and 35 years in Berlin, Germany. Methods: We introduce soulspace as easily accessible mental health care for young people, and we characterize soulspace along the lines of the internationally established eight key principles of integrated youth mental health services (Killackey, et al., 2020, World Economic Forum). Soulspace is a cooperation between clinical outpatient units of psychiatric clinics for adolescents and young adults as well as a community‐based counselling service. It provides initial contact, counselling, diagnostics, and treatment. Results: Our analyses of the pathways to soulspace and the characteristics of the soulspace users suggest that the low threshold is a facilitator to help finding for young people in comparison to more conventional early intervention models. That is, having transferred the early intervention center in a youth‐facing counselling service as was done in soulspace seems to have reduced the threshold to seek help for families and for young people in need for support. Conclusions: In summary, with soulspace, an easily accessible mental health care service was established that integrates counselling and specialized psychiatric treatment if needed. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion Adolescent mental ill‐health is a common international challenge affecting both high‐ and lower‐middle‐income countries. The Republic of the Philippines enacted its first mental health law in 2019, underlining the importance of the promotion of adolescent mental health education in schools. In Japan, course instructions about mental ill‐health were formulated in a Course of Study that reflects governmental curriculum guidelines. Embedded since 2022, the Course of Study aimed to promote an understanding of current issues of adolescent health. The National Center for Global Health and Medicine in Japan has been sharing experience of promoting public health practices and advancing medical technology in low‐ and middle‐income countries, especially in the Western Pacific region. This paper describes the development process and content of these resources by an interdisciplinary team from Japan and the Philippines.The interdisciplinary team created an embedded mental health education programme using animated videos for the Philippine school curriculum to improve mental health literacy in adolescents.Two six‐minute animated videos of age‐relevant stories were created. The animation scenarios illustrate: 1) mental health problems and recovery; and 2) major symptoms of mental illnesses, including depression, anxiety, and schizophrenia. Each animated video presents several items for discussion among students and/or teachers, both in class and online for students unable to attend school.Our efforts may provide good opportunities for enhancing adolescents' mental health activities in the Philippines. In the following steps, we should investigate the effectiveness of school‐based MHL using these animated videos with rigorous evaluation methods. [ABSTRACT FROM AUTHOR]

Aims Method Results Conclusions Poor sleep is highly prevalent in young people and increases risk of mental health difficulties, yet access to sleep interventions remains limited. This paper evaluates the use of a sleep intervention delivered by non‐expert practitioners in a secondary care youth mental health service.Assistant psychologists were trained to deliver a six‐session 1:1 cognitive‐behavioural sleep intervention adapted for use with young people with mental health difficulties. A within‐subject design assessed clinical outcomes relating to sleep (Insomnia Severity Index), psychological distress and personal goals (Goal Based Outcome Measures) at four time points.High referral, intervention take‐up (82.82%) and completion (70%) rates were reported, together with high baseline levels of insomnia (Insomnia Severity Index mean 20.47, SD 3.68) and poor sleep efficiency (56.36%, SD 17.23). Fifty‐six young people (average age 19.2 years, SD 3.25) were included in the outcome analysis. Statistically and clinically significant improvements were seen across all outcome measures, with 68% no longer meeting clinical threshold (ISI ≥15) for insomnia at endpoint.This study demonstrates exceptionally high levels of clinical need and engagement with a sleep intervention adapted specifically for young people with mental health difficulties. Whilst limited by the uncontrolled design, large improvements in insomnia and psychological distress support its effectiveness and utility in clinical settings. More robust implementation and evaluation is warranted in broader youth mental health services to promote earlier access. [ABSTRACT FROM AUTHOR]

Aims: High rates of mental illness among individuals experiencing homelessness, as well as documented contacts with psychiatric services prior to episodes of homelessness, indicate that early intervention could play a key role in homelessness prevention. Decision‐makers and clinical teams need longitudinal data on housing trajectories following initial contact with psychiatric services, as well as on predictors of risk of housing instability and homelessness. This paper describes the AMONT study, a mixed‐methods naturalistic longitudinal cohort study of individuals identified as new psychiatric service users in seven clinical sites across the province of Québec (Canada). Methods: The goal of AMONT is to examine the housing situations of individuals over 36 months after their initial contact with psychiatric services, and to identify environmental and individual correlates and predictors of housing outcomes. Participants complete a broad battery of instruments at baseline and follow‐up assessments after 24 and 36 months. We explore housing stability following an initial episode of psychiatric service use from the perspective of service users, family members, and service providers, through qualitative interviews. Results and Conclusions: The findings from the AMONT study will yield a better understanding of the residential pathways of individuals with mental illness, from their first contact with psychiatric services and for 3 years subsequently. This will inform service providers, decision‐makers and managers on the specific housing concerns and issues that affect first‐time mental health service users. This in turn can lead to the development and implementation of evidence‐informed practices and policies that aim to prevent instability and homelessness. [ABSTRACT FROM AUTHOR]

Background: The clinical staging model states that psychosis develops through subsequent stages of illness severity. To better understand what drives illness progression, more extensive comparison across clinical stages is needed. The current paper presents an in‐depth characterization of individuals with different levels of risk for psychosis (i.e., different early clinical stages), using a multimethod approach of cross‐sectional assessments and daily diary reports. Methods: Data came from the Mirorr study that includes N = 96 individuals, divided across four subgroups (n1 = 25, n2 = 27, n3 = 24, and n4 = 20). These subgroups, each with an increasing risk for psychosis, represent clinical stages 0‐1b. Cross‐sectional data and 90‐day daily diary data on psychopathology, well‐being, psychosocial functioning, risk and protective factors were statistically compared across subgroups (stages) and descriptively compared across domains and assessment methods. Results: Psychopathology increased across subgroups, although not always linearly and nuanced differences were seen between assessment methods. Well‐being and functioning differed mostly between subgroup 1 and the other subgroups, suggesting differences between non‐clinical and clinical populations. Risk and protective factors differed mostly between the two highest and lowest subgroups, especially regarding need of social support and coping, suggesting differences between those with and without substantial psychotic experiences. Subgroup 4 (stage 1b) reported especially high levels of daily positive and negative psychotic experiences. Conclusions: Risk for psychosis exists in larger contexts of mental health and factors of risk and protection that differ across stages and assessment methods. Taking a broad, multi‐method approach is an important next step to understand the complex development of youth mental health problems. [ABSTRACT FROM AUTHOR]

Aim: Previous research has indicated that individuals expressing high schizotypal traits and patients with Schizotypal Personality Disorder (SPD), show deficits in facial emotion recognition, compared to low schizotypal or control groups. On the other hand, non‐significant findings also exist and the association of facial emotion recognition deficits with the different schizotypal dimensions is not well defined, thus limiting any conclusive outcomes. Therefore, the aim of this systematic review was to further clarify this relationship. Methods: PsychInfo, Web of Science, Scopus and PubMed were systematically searched, and 23 papers with a cross‐sectional design were selected. Nineteen studies examined individuals with high schizotypal traits and four studies evaluated SPD individuals with behavioural facial emotion recognition paradigms and self‐report measures or clinical interviews for schizotypal traits. All selected studies were published between 1994 and August 2020. Results: According to the evidence of studies, high schizotypal individuals and SPD patients have poorer performance in facial emotion recognition tasks. Negative schizotypy was related to lower accuracy for positive and negative emotions and faster emotion labeling while positive schizotypy was associated with worse accuracy for positive, negative and neutral emotions and more biases. Disorganized schizotypy was associated with poorer accuracy for negative emotions and suspiciousness with higher accuracy for disgust faces but lower total accuracy. Conclusions: These findings are consistent with the vulnerability for schizophrenia spectrum disorders and support the idea that emotion recognition deficits are trait markers for these conditions. Thus, the effectiveness of early‐intervention programmes could increase by also targeting this class of deficits. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion Educational attainment is consistently highly valued by young people with mental ill health, yet maintenance and completion of education is a challenge. This paper reports on the implementation of a supported education programme for youth mental health.Between 10 October 2019 and 10 October 2020, a supported education programme was delivered within primary and tertiary youth mental health services. A description of the programme, context, and adjustments required due to COVID‐19 is presented, and the educational outcomes of young people referred to the programme were explored. Two case studies are also presented.The programme received 71 referrals over this period, of which 70.4% had not yet completed secondary school and 68% were experiencing multiple mental health conditions. Overall outcomes were positive, with 47.5% of the 40 young people who chose to engage with the programme maintaining or re‐engaging with education. However, the remainder of those who engaged withdrew from the programme, often reporting challenges due to COVID‐19 such as social isolation or increased uncertainty. Additionally, a number of young people declined or disengaged from the programme to focus on employment.This report of the experience of integrating a supported employment programme in Australian youth mental health services reinforces the need for such support, and provides preliminary evidence for its successful implementation as part of routine care. The disengagement in response to COVID‐19 highlights the real‐world challenges of the pandemic, while young people's voicing of employment goals indicates the need for combined educational and vocational support—to assist transition and progression between these goals. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Resilience is a broad and dynamic concept that can be seen as being constituted by the combination of internal factors, for example, temperament profiles, and external factors, for example, social support. This paper aimed to identify temperament profiles in help‐seeking youth exposed to adverse childhood experiences, and to investigate whether temperament (putative internal protective factor) interacts with social schemas (as proxy for the putative external protective factor social support) such that their combination is associated with (a) reduced mental health problems and (b) attenuated decrease in positive affect following daily life stressors.Self‐report questionnaires were used to measure temperament, social schemas and mental health problems. The experience sampling method was used to assess stress and positive affect (i.e., stress‐sensitivity as a potential daily life resilience mechanism). Temperament profiles were identified by latent profile analysis and regression analyses were used to examine (interaction) effects.In 138 subjects, three temperament profiles were identified, that is, a moderate, volatile and persevering profile, of which the latter was negatively associated with mental health problems. Neither mental health problems nor stress sensitivity were found to be affected by the interaction between temperament and social schemas. However, positive social schemas were found to be independently associated with reduced mental health problems (b = −4.41; p = <.001) and reduced stress sensitivity (b = .10, p = .044).Findings are relevant for both practice and research, and contribute to improving our understanding of putative protective factor in the development of mental ill‐health, thereby further unravelling the construct of resilience. [ABSTRACT FROM AUTHOR]

Aim: Basic self disturbance is a putative core vulnerability marker of schizophrenia spectrum disorders. The primary aims of the Self, Neuroscience and Psychosis (SNAP) study are to: (1) empirically test a previously described neurophenomenological self‐disturbance model of psychosis by examining the relationship between specific clinical, neurocognitive, and neurophysiological variables in UHR patients, and (2) develop a prediction model using these neurophenomenological disturbances for persistence or deterioration of UHR symptoms at 12‐month follow‐up. Methods: SNAP is a longitudinal observational study. Participants include 400 UHR individuals, 100 clinical controls with no attenuated psychotic symptoms, and 50 healthy controls. All participants complete baseline clinical and neurocognitive assessments and electroencephalography. The UHR sample are followed up for a total of 24 months, with clinical assessment completed every 6 months. Results: This paper presents the protocol of the SNAP study, including background rationale, aims and hypotheses, design, and assessment procedures. Conclusions: The SNAP study will test whether neurophenomenological disturbances associated with basic self‐disturbance predict persistence or intensification of UHR symptomatology over a 2‐year follow up period, and how specific these disturbances are to a clinical population with attenuated psychotic symptoms. This may ultimately inform clinical care and pathoaetiological models of psychosis. [ABSTRACT FROM AUTHOR]

Aim: Research has shown that preventative intervention in individuals at ultra‐high risk of psychosis (UHR) improves symptomatic and functional outcomes. The staged treatment in early psychosis (STEP) trial aims to determine the most effective type, timing and sequence of interventions in the UHR population by sequentially studying the effectiveness of (1) support and problem solving, (2) cognitive‐behavioural case management and (3) antidepressant medication with an embedded fast‐fail option of (4) omega‐3 fatty acids or low‐dose antipsychotic medication. This paper presents the recruitment flow and baseline clinical characteristics of the sample. Methods: STEP is a sequential multiple assignment randomized trial. We present the baseline demographics, clinical characteristics and acceptability and feasibility of this treatment approach as indicated by the flow of participants from first contact up until enrolment into the trial. Recruitment took place between April 2016 and January 2019. Results: Of 1343, help‐seeking young people who were considered for participation, 402 participants were not eligible and 599 declined/disengaged, resulting in a total of 342 participants enrolled in the study. The most common reason for exclusion was an active prescription of antidepressant medication. Eighty‐five percent of the enrolled sample had a non‐psychotic DSM‐5 diagnosis and symptomatic/functional measures showed a moderate level of clinical severity and functional impairment. Discussion: The present study demonstrates the acceptability and participant's general positive appraisal of sequential treatment. It also shows, in line with other trials in UHR individuals, a significant level of psychiatric morbidity and impairment, demonstrating the clear need for care in this group and that treatment is appropriate. [ABSTRACT FROM AUTHOR]

Aim: Lived experience adaptation of mental health interventions can help ensure that the intervention is appropriate for the target population. This paper describes a youth‐led adaptation of a self‐stigma reduction intervention for young adults with bipolar spectrum disorders, that is, Narrative Enhancement and Cognitive Therapy. Methods: Standard guidelines for youth engagement were followed. A youth lived experience adaptation lead and a five‐member youth lived experience advisory panel reviewed the intervention and made a number of adaptations to increase its relevance for young people with bipolar disorders. A brief evaluation of the engagement process was conducted. Results: The primary adaptations made to the intervention fell into five areas: (1) wording revisions for recovery‐oriented language accessible to youth with a wide variety of language and literacy levels; (2) updating and tailoring to the diagnostic category, with the addition of new quotes describing the lived experience of stigma; (3) integration of a new, engaging graphic design; (4) development of a goal‐setting module, as recommended by the research team; and (5) identification of the role of a peer co‐facilitator. An evaluation of the engagement process showed that the engagement was extremely meaningful for the youth engaged. Conclusions: Using a youth lived experience adaptation process, young people can make relevant, important changes to a psychosocial intervention. The resulting early intervention materials are research‐ready and are hypothesized to meet the needs of young people with BD in a youth‐friendly manner. Research on the acceptability, efficacy, and effectiveness of the newly adapted intervention will be required. [ABSTRACT FROM AUTHOR]

Background: Specialist early intervention (SEI) service models are designed to treat symptoms, promote social and vocational recovery, prevent relapse, and resource and up‐skill patients and their families. The benefits of SEI over the first few years have been demonstrated. While early recovery can be expected to translate to better long‐term outcomes by analogy with other illnesses, there is limited evidence to support this from follow‐up studies. The current study involves the long‐term follow‐up of a sub‐set of first episode psychosis (FEP) patients, with a range of diagnoses, who were first treated at Orygen's Early Psychosis Prevention and Intervention Centre (EPPIC) between 1998 and 2000. The aim of this paper is to present the methodology for this follow‐up study. Methods: Between January 1998 and December 2000, 786 patients between the ages of 15–29 years were treated at EPPIC, located in Melbourne, Australia. Our cohort consists of 661 people (82 were transferred/discharged and 43 were not diagnosed with a psychotic disorder at time of discharge). The 18‐month treatment characteristics of this cohort have been extensively examined in the First Episode Psychosis Outcome Study (FEPOS). The ≥15 year outcomes of this cohort are being examined in this study, known as FEPOS15. Results: Participant follow‐up is ongoing. In order to extend and assess broader outcomes of the cohort, data linkage with health‐related databases will be conducted. Conclusion: This study will provide a comprehensive evaluation of the long‐term trajectory of psychotic disorders after treatment for FEP in a SEI service. [ABSTRACT FROM AUTHOR]

Background: There are growing calls to engage service users in research about issues relevant to them. Youth and family members can make meaningful contributions to research projects, improving quality and relevance. However, more information is needed on the contributions that youth and family members can make to various study designs. Objective: This paper describes the contributions that youth and family members have made to a multi‐site pragmatic randomized‐controlled trial, YouthCan IMPACT, and the way project‐based engagement learnings accelerated change at the institutional level and beyond. Results: Youth and family members were full members of the project team, including the project's core governance and working groups. They contributed to project leadership, as funding co‐applicants and as equal members of the governance team. They were also engaged in study design. Youth defined the primary outcome measure and contributed to decisions on all secondary measures. The service pathway was co‐designed with youth and family members; for example, they guided the inclusion of peer support and a family member intervention as core service components. Study implementation contributions included ensuring a youth‐ and family‐friendly research process and training research staff on working with youth and family members. Knowledge translation activities have included youth and family members as co‐presenters and manuscript co‐authors. The learnings from this trial have been leveraged to expand youth and family engagement at the institution and beyond. Conclusions: Youth and family members make substantial contributions to complex research projects, including randomized‐controlled trials, thereby improving project design, study implementation, associated interventions, and knowledge translation. [ABSTRACT FROM AUTHOR]

Aim: Early intervention for psychosis has been of high interest in the past two decades. Research demonstrates that clinical high risk for psychosis (CHR‐p) populations experience impairments in role functioning. Although several vocational and cognitive interventions exist for people living with psychosis, there are no known evidence‐based treatments for role functioning difficulties during the CHR‐p stage. There is clear evidence for a need for interventions that directly target role functioning. Methods: This paper describes the theoretical development and implementation of a novel intervention targeting role functioning impairments: Individualized Vocational and Educational Support and Training (InVEST). The CEDAR Clinic, a specialized CHR‐p coordinated specialty care (CSC) team, has worked to develop InVEST to target core aspects of role functioning, namely executive functioning, stress sensitivity, and task initiation. The intervention is cost‐efficient, as bachelor level clinicians provide the service under supervision of licensed clinicians. This summary describes InVEST, provides a disguised case example, and presents initial exploratory data (N = 135) focused on the intervention's feasibility in this CSC program. Results: Although these preliminary data are limited, available information suggests that InVEST may provide a core treatment modality within CHR‐p treatment programs. Conclusions: More research formally investigating InVEST with a larger sample would provide further evidence of the intervention's efficacy. [ABSTRACT FROM AUTHOR]

Background: No biological treatment has been firmly established for the at‐risk stage of psychotic disorder. In this study we aim to test if subthreshold psychotic symptoms can be effectively treated with cannabidiol (CBD), a non‐psychoactive compound of the plant Cannabis sativa. The question has taken on increased importance in the wake of evidence questioning both the need and efficacy of specific pharmacological interventions in the ultra‐high risk (UHR) for psychosis group. Methods: Three‐arm randomized controlled trial of 405 patients (135 per arm) aged 12–25 years who meet UHR for psychosis criteria. The study includes a 6‐week lead‐in phase during which 10% of UHR individuals are expected to experience symptom remission. Participants will receive CBD (per oral) at doses 600 or 1000 mg per day (fixed schedule) for 12 weeks. Participants in the third arm of the trial will receive matching placebo capsules. Primary outcome is severity of positive psychotic symptoms as measured by the Comprehensive Assessment of At‐Risk Mental States at 12 weeks. We hypothesize that CBD will be significantly more effective than placebo in improving positive psychotic symptoms in UHR patients. All participants will also be followed up 6 months post baseline to evaluate if treatment effects are sustained. Conclusion: This paper reports on the rationale and protocol of the Cannabidiol for At Risk for psychosis Youth (CanARY) study. This study will test CBD for the first time in the UHR phase of psychotic disorder. [ABSTRACT FROM AUTHOR]

Aim: First use of opioids often happens in adolescence and an increasing number of opioid overdoses are being reported among youth. The purpose of this narrative review was to present the treatment approaches for youth with high‐risk opioid use, determine whether the literature supports the use of opioid agonist treatment among youth and identify evidence for better treatment outcomes in the younger population. Methods: A search of the literature on PubMed using MeSH terms specific to youth, opioid use and treatment approaches generated 1436 references. Following a screening process, 137 papers were found to be relevant to the treatment of high‐risk opioid use among youth. After full‐text review, 19 eligible studies were included: four randomized controlled trials, nine observational studies and six reviews. Results: Research for the different treatment options among youth is limited. The available evidence shows better outcomes in terms of retention in care and cost‐effectiveness for opioid agonist treatment than abstinence‐based comparisons. Integrating psychosocial interventions into the continuum of care for youth can be an effective way of addressing comorbid psychiatric conditions and emotional drivers of substance use, leading to improved treatment trajectories. Conclusions: From the limited findings, there is no evidence to deny youth with high‐risk opioid use the same treatment options available to adults. A combination of pharmacological and youth‐specific psychosocial interventions is required to maximize retention and survival. There is an urgent need for more research to inform clinical strategies toward appropriate treatment goals for such vulnerable individuals. [ABSTRACT FROM AUTHOR]

Aims: Developing early intervention services (EIS) in healthcare organizations (HCOs) is difficult because it is necessary to integrate service approaches across units. To accommodate the needs of patients and relatives, Oslo University Hospital (OUH) chose to use service design (SD) to redesign their first‐episode services with an emphasis on easy access to care. This paper discusses the results and how SD can help to overcome known barriers to change in complex organizations. Method: SD is a method that relies on principles of participation, innovation and visualization to develop coherent services. The method emphasizes the exploration of a problem area from the perspective of multiple stakeholders to create a shared understanding of the complexity. Idea generation, visualization and early modelling of possible solutions are employed to test alternatives involving stakeholders. Results: A low threshold EIS was developed. A helpline with a specialist managing the phone was established. High‐quality assessment regarding possible psychosis development was thus made available to patients, relatives and professionals, eliminating the need for paper referral. This approach was supported by a communication strategy that includes web‐based information. A dedicated cross‐specialist team was established to increase collaboration in complex cases. Finally, outreach services were improved. Conclusion: SD is a suitable method to incorporate the views of different stakeholders (patients, relatives and professionals) to develop EIS services in complex organizations and can help overcome known barriers to change in HCOs. [ABSTRACT FROM AUTHOR]

Aim: The aim of this narrative summary was to examine the efficacy of physical activity and exercise as a universal prevention for depression in young people. Methods: We conducted a search of the literature in the open‐access evidence database of controlled trials and systematic reviews in youth mental health, an initiative between Orygen, The National Centre of Excellence in Youth Mental Health and headspace, National Youth Mental Health Foundation. In April 2018, we searched for all papers published between 1980 and 2017 relating to "Depressive Disorder" under the "Universal Prevention" illness stage and classified as "Physical activity/Exercise" under the treatment/intervention classification. Systematic reviews, randomized control trials (RCTs) and controlled clinical trials were all included. Results: A total of 11 papers were returned. Three of these studies were observational and eight studies were controlled trials. The reviewed studies indicate that exercise and physical activity might be an effective universal depression prevention intervention for young people. Three of the controlled studies had a passive control group or no control group and only one study had longer‐term follow‐up. No trial used a longitudinal design to determine if interventions prevent the onset of new cases of depression. Conclusions: The studies reviewed in the current review demonstrate a bidirectional relationship between physical activity, exercise and adolescent mental health. The results of the current review suggest that physical activity and exercise programs designed to increase the level of activity in young people should be implemented to be attractive and achievable to young people that may have poor psychological health. [ABSTRACT FROM AUTHOR]

Aim: Demands for mental health services in post‐secondary institutions are increasing. This paper describes key features of a response to these needs: ACCESS Open Minds University of Alberta (ACCESS OM UA) is focused on improving mental health services for first‐year students, as youth transition to university and adulthood. Methods: The core transformation activities at ACCESS OM UA are described, including early case identification, rapid access, appropriate and timely connections to follow‐up care and engagement of students and families/carers. In addition, we depict local experiences of transforming existing services around these objectives. Results: The ACCESS OM UA Network has brought together staff with diverse backgrounds in order to address the unique needs of students. Together with the addition of ACCESS Clinicians these elements represent a systematic effort to support not just mental health, but the student as a whole. Key learnings include the importance of community mapping to developing networks and partnerships, and engaging stakeholders from design through to implementation for transformation to be sustainable. Conclusions: Service transformation grounded in principles of community‐based research allows for incorporation of local knowledge, expertise and opportunities. This approach requires ample time to consult, develop rapport between staff and stakeholders across diverse units and develop processes in keeping with local opportunities and constraints. Ongoing efforts will continue to monitor changing student needs and to evaluate and adapt the transformations outlined in this paper to reflect those needs. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to describe the entry protocol of the Prevention and Early Intervention for Psychosis Program (PEPP)‐Montreal, an early intervention program for psychosis. The protocol is designed to fulfil a key objective of the early intervention movement—reducing delays to accessing high‐quality care. The paper also aims to describe how this rapid entry protocol can be deployed in other services interested in reducing delays in initiating treatment. Methods: PEPP provides rapid, easy access to quality care by placing a single, well‐trained professional, the intake clinician, at the point of entry. Anyone can refer a youth directly and without formalities to the intake clinician who responds promptly and sensitively to all help‐seeking, whether by a youth, a family member, a school counsellor or anyone acting on behalf of a youth in need. To promote accessibility, PEPP guarantees an initial assessment within 72 hours; maintains relationships with referral sources; and conducts awareness‐enhancing outreach activities. Results: Since 2003, PEPP has received 1750 referrals, which have all been responded to within 72 hours. Families have been involved in the intake process in 60% of the cases and hospitalization may have been averted in over half of the referrals originating from emergency‐room services. Another indicator of success is the very low turnover in the intake clinician's position. Overall, the PEPP model has succeeded in providing rapid, engaging, easy and youth‐friendly access to high‐quality care. Conclusion: The success of this protocol at PEPP has inspired the entry protocols at other first‐episode psychosis services. Its ability to provide rapid, engaging access to high‐quality services may allow this protocol to become a model for other early intervention services for psychosis and other mental illnesses. [ABSTRACT FROM AUTHOR]

Aim: Poor functioning has become a hallmark of many youth at clinical high‐risk (CHR) of psychosis. Even for those who do not make the transition to psychosis remain troubled by functional deficits and a decline in functioning increases the odds of transitioning to psychosis. There are very few treatment studies that have attempted to improve social and role functioning. The aim of this paper is to describe the methods of a treatment study to address social and role functioning in CHR. Methods: This was a randomized controlled trial of cognitive‐behavioural social skills training (CBSST) versus a supportive therapy. CBSST combines elements of cognitive behaviour therapy (CBT) and social skills training (SST), two evidence‐based treatments for schizophrenia. By adding CBT to SST to target functioning outcomes, SST can be used to train new social skills, and thoughts that interfere with skilled performance in the real world can be addressed using CBT. We developed an adapted version of CBSST, more appropriate for the age range and illness severity of typical CHR individuals, to attempt to show improvements in social and role functioning for these young people. Results: Two hundred and three participants were recruited for this study. Results include initial baseline data. Conclusion: This article describes the baseline methodology of a CHR youth who have difficulties in social and/or role functioning. It is one of the first clinical trials to address this significant problem. [ABSTRACT FROM AUTHOR]

Aims Psychotic-like experiences (PLEs) or subclinical psychotic experiences have received increased attention as some studies have suggested continuity between PLEs and psychotic disorders. However, epidemiological and correlational studies of PLEs showed mixed findings - it is observed that different studies use a wide variety of definitions of PLEs, as well as different assessment tools that are designed to capture such described experiences. The differences in definitions and assessment tools adopted could contribute to the discrepancy of findings. The current review aims to examine the definitions and assessment tools adopted in the studies of PLEs. Methods Literature search was conducted between October 2013 and February 2014 using three search engines: Medline, Web of Science and Pub Med. Results A total of 76 papers met the selection criteria and were included in the current review. It is found that the majority of papers reviewed defined PLEs quantitatively using assessment tools and do not have a specific phenomenological definition, whereas assessment tools adopted have a wide variety. Furthermore, phenomenological studies of PLEs were rare. Conclusions The variations in definitions and assessment tools of PLEs might contribute to mixed findings in researches. Reaching to a consensus through the study of phenomenology of PLEs is essential to further advancement of the research in this area. [ABSTRACT FROM AUTHOR]

Background: Mental disorders are widespread among students. However, mental health help‐seeking remains low. Several reviews and meta‐analyses have shown that the main barrier to seeking help from mental health professionals is stigma. This paper aimed to assess stigma in a sample of students, and its association with help‐seeking intentions and comfort with disclosing a mental illness. Method: The 'Community Attitudes toward the Mentally Ill', the 'Mental Health Knowledge Schedule', and the 'Reported and Intended Behaviour Scale' were administered to a total of 714 college students (62.2% female; mean age = 20.9). Results: We found that 43.8% of students agreed that one of the main causes of mental illness is a lack of self‐discipline and willpower, 21.9% did not consider depression as a mental illness, and 39.6% felt that they would be 'unlikely' or 'very unlikely' to seek the help of a health professional for mental health problems. Females had higher scores in help‐seeking intentions (p <.001) and knowledge of mental illness (p =.019). Students' age negatively correlated with knowledge (p <.001, r = −.147). Pearson correlations indicated that help‐seeking intentions positively correlated with more favourable future intentions of being in contact with a person with a mental illness (p <.001, r =.103) and greater mental health knowledge (p <.001, r =.163); and that comfort with disclosing significantly and negatively correlated with attitudes (p <.001, r = −.125). Conclusion: To date, few young people see mental health professionals as a preferred source of support, and action is needed to change this perception or reform mental health services to make them more attractive to this age group. [ABSTRACT FROM AUTHOR]

Aim: Pathways to care are well studied in the First Episode Psychosis field, but less attention has been given to At‐Risk Mental States or prodromal psychosis. This is important because accessing appropriate help at the earliest opportunity is likely to improve outcomes, particularly for those who make transition to psychosis. The present systematic review aimed to synthesize the available literature on pathways to care in ARMS or prodromal psychosis, and investigate the barriers and facilitators to receiving care for ARMS. Methods: The CINAHL Complete, EMBASE, Medline Complete, PsycINFO and PubMED databases were searched. Studies were included if they were published in English between 1985 and 2019, where reported data came exclusively from an At‐Risk Mental State population, and the study described or related to pathways to care. Results: Ten studies met the inclusion criteria, of which 8 were quantitative. Screening tools and pathways to care instruments varied. Mental health professionals, and general practitioners played a key role in help seeking. Family involvement was also found to be an important factor. Conclusions: Pathways to care research in At‐Risk Mental States are more scarce than in the field of First Episode Psychosis. More research is warranted, especially concerning the role of patient‐level characteristics on pathways to care. A validated measure of pathways to care may also be of benefit. [ABSTRACT FROM AUTHOR]

Background: First‐episode psychosis typically has its onset during adolescence. Prolonged deficits in social functioning are common in FEP and yet often variance in functioning remains unexplained. Developmental psychology frameworks may be useful for understanding these deficits. Eudaimonic well‐being (EWB), or positive self‐development, is a developmental psychology construct that has been shown to predict mental health outcomes across multiple populations but has not been systematically reviewed in FEP. Aim: Our aim was to systematically review the evidence for: the predictors of EWB, the effectiveness of EWB interventions and to examine the quality of this research in FEP. Methods: Selected studies measured either composite or components of EWB. A systematic search produced 2876 abstracts and 122 articles were identified for full screening which produced 17 final papers with 2459 participants. Results: Studies comprised six RCTs, eight prospective follow‐up studies and three case‐controlled studies. Self‐esteem and self‐efficacy were the most commonly measured components. A meta‐analysis of RCTs revealed no statistically significant effect of interventions on self‐esteem. The extant research indicates that character strengths may be associated with higher EWB. Self‐esteem may be lower in FEP compared with age matched controls but not different from ultra‐high risk patients. Self‐esteem appears to be associated with poorer insight and improved therapeutic alliance. Significant problems with both external and internal validity of reviewed studies were apparent. Conclusions: The hypotheses that lowered EWB is a risk factor for both onset of FEP and for poorer functional outcomes warrant further investigation. There is currently no evidence for effective interventions for EWB in FEP. [ABSTRACT FROM AUTHOR]

Aim: Individuals with psychotic disorders have poorer health outcomes and die earlier due to cardiovascular diseases when compared to healthy populations. Contributing factors include low levels of physical activity, poor nutrition and tobacco smoking. Currently, patients navigate a fragmented health‐care system to seek physical and mental health services, often without access to evidence‐based health promotion interventions, especially in non‐academic settings or rural areas, increasing client barriers at the individual and provider level. To address these gaps, we wish to test the feasibility and impact of a Technology‐Enabled Collaborative Care for Youth (TECC‐Y) model to improve healthy behaviours among youth with early psychosis. The model addresses geographical barriers and maldistribution of physical and mental health care. Methods: A randomized controlled trial, including youth (ages of 16‐29) with early psychosis (diagnosed in the past 5 years) residing in Ontario, Canada. Our primary outcome is client engagement. Secondary outcomes include smoking status, physical health and nutrition. Participants are randomly assigned to either a health coach supervised by a virtual care team, or a self‐directed learning group (e‐platform with psychoeducational materials). Assessments are conducted at baseline, 6, 12 and 24 weeks. Results: This paper presents the protocol of the study. Recruitment commenced in August 2018. This study was registered on 16 July 2018 on clinicaltrials.gov (Registry ID: NCT03610087). Conclusions: TECC‐Y will determine if a technology‐based collaborative care model engages youth with early psychosis, and whether this will be associated with changes in smoking, physical health and nutrition. [ABSTRACT FROM AUTHOR]

Aim: One of the basic challenges of Early Psychosis Intervention (EPI) programs for rural populations is translating best practice which developed for urban high-population density areas to rural and remote settings. This paper presents data from two different models (hub and spoke and specialist outreach) of rural EPI practice in Ontario, Canada. Methods: This cross-sectional study used a convenience sample of clients from two rural EPI programs between 2005 and 2007. Data about client outcomes specific to general functioning, admissions to hospital and emergency room (ER) visits were collected. For all dichotomous variables, chisquare tests were used to test differences between two groups. Results: The total clients served in hub and spoke were 457 compared to 91 in specialist outreach. Although not statistically significant, the hub and spoke group showed better functioning in the community. There was a significant difference between the two groups with regard to hospital admissions. Although not significant, there was a greater percentage (58.3%) of specialist outreach clients who visited the ER in the previous 12 months as compared to clients serviced by the hub and spoke model (34.9%). Conclusions: The observed data from these two rural models suggest that there may be differing outcomes. There are limitations to this study, and this paper does not address why there are differences. Future work needs to continue to further explore why differences exist and whether they persist so we can provide equity and quality care for rural and remote populations. [ABSTRACT FROM AUTHOR]

Aim One of the basic challenges of Early Psychosis Intervention ( EPI) programs for rural populations is translating best practice which developed for urban high-population density areas to rural and remote settings. This paper presents data from two different models ( hub and spoke and specialist outreach) of rural EPI practice in Ontario, Canada. Methods This cross-sectional study used a convenience sample of clients from two rural EPI programs between 2005 and 2007. Data about client outcomes specific to general functioning, admissions to hospital and emergency room (ER) visits were collected. For all dichotomous variables, chi-square tests were used to test differences between two groups. Results The total clients served in hub and spoke were 457 compared to 91 in specialist outreach. Although not statistically significant, the hub and spoke group showed better functioning in the community. There was a significant difference between the two groups with regard to hospital admissions. Although not significant, there was a greater percentage (58.3%) of specialist outreach clients who visited the ER in the previous 12 months as compared to clients serviced by the hub and spoke model (34.9%). Conclusions The observed data from these two rural models suggest that there may be differing outcomes. There are limitations to this study, and this paper does not address why there are differences. Future work needs to continue to further explore why differences exist and whether they persist so we can provide equity and quality care for rural and remote populations. [ABSTRACT FROM AUTHOR]

Aim: Early intervention in psychosis (EIP) is a well‐established approach with the intention of early detection and treatment of psychotic disorders. Its clinical and economic benefits are well documented. This paper presents basic aspects of EIP services, discusses challenges to their implementation and presents ideas and strategies to overcome some of these obstacles. Methods: This paper is a narrative review about the evidence supporting EIP, with examples of successful implementation of EIP and of cases where major obstacles still need to be overcome. Results: Experience from successfully implemented EIP services into the mental healthcare system have generated evidence, concepts and specific strategies that might serve as guidance or inspiration in other countries or systems where EIP is less well developed or not developed at all. Previous experience has made clear that evidence of clinical benefits alone is not enough to promote implementation, as economic arguments and political and social pressure have shown to be important elements in efforts to achieve implementation. Conclusions: Users’ narratives, close collaboration with community organizations and support from policy‐makers and known people within the community championing early intervention (EI) services are just a few of the approaches that should be considered in campaigns for implementation of EI services. Fast progress in implementation is possible. [ABSTRACT FROM AUTHOR]

The Early Psychosis Prevention and Intervention Centre Statewide Services (ESW) team provides training for multidisciplinary clinicians that specialise in early psychosis across the State of Victoria, Australia. The aim of this paper is to describe the 4‐phase approach utilised by ESW to prepare for and deliver workshops, to report on participants’ ratings of the ESW workshops, and to make recommendations for other trainers of early psychosis clinicians. Between March 2009 and September 2014, ESW provided 85 training workshops that had a strong focus on evidence‐based approaches and international guidelines, and utilized clinical examples of early psychosis interventions. At the conclusion of each workshop, participants were asked to complete a questionnaire that comprised qualitative and quantitative elements. These assessed perceived trainer knowledge, learning, interactivity and specific topic feedback. The focus of this paper will be on describing the quantitative data resulting from these questionnaires. A total of 1708 clinicians provided feedback on the 85 workshops. There was a high level of compliance, with 83.0% of workshop participants completing the questionnaires. Feedback was positive across all areas, with the 2 areas that were most highly endorsed being that presenters “appeared to know their subject matter well” (endorsed by 98.4% of participants) and that “topics were explained well” (endorsed by 96.8% of participants). Training for early psychosis clinicians that focusses on core clinical topics, is well planned, incorporates feedback from previous training, and is based on adult learning principles, is likely to be effective and well received by early psychosis clinicians. [ABSTRACT FROM AUTHOR]

Aim: Existing children and adolescent mental health services in the United Kingdom have many gaps, such as reduced access to community‐based services, and a lack of early intervention, prevention, and 24/7 crisis care. These gaps prevent timely access to appropriate levels of care, decrease children and young people's engagement with providers, and lead to increased pressures on urgent and emergency care. In this paper, we outline a newly created 0‐19 model and its crisis service, which have been transformed into a fully integrated, "joint partnership" service, in line with the recommendations from the recent UK policies that aim to meet the aforementioned challenges. Method: The "Solar" service is described as a case study of a 0‐19 service model. We cover the national and local contexts of the service, in addition to its rationale, aims, organizational structure, strengths and limitations. Results: The presented model is a fully integrated and innovative example of a service model that operates without tiers, and helps to create an inclusive, compassionate, stigma‐free and youth‐friendly environment. Additionally, the model aims to prioritize recovery, early intervention, prevention and the development of resilience. Conclusion: The 0‐19 model is a result of the recent transformation of children and youth mental health services in the United Kingdom. The ongoing evaluation of the 0‐19 model and its crisis component will investigate the model's effectiveness, accessibility and acceptability, as well as understanding the potential of the model to contribute towards solving numerous gaps in the existing mental health service provision within the United Kingdom. [ABSTRACT FROM AUTHOR]

Aim: The aim of this paper is to describe the substance use of participants who are at‐risk for serious mental illness (SMI). Method: The Canadian Psychiatric Risk and Outcome study (PROCAN) is a two‐site study of 243 youth and young adults aged 13 to 25 years, categorized into four groups: healthy controls (n = 42), stage 0 (asymptomatic individuals with risk of SMI typically family high risk; n = 41), stage 1a (distress disorder or mild symptoms of anxiety or depression; n = 53) and stage 1b (attenuated syndromes, including bipolar disorder or psychosis; n = 107). Substance use measures were administered at baseline, 6‐ and 12‐months. Results: At baseline, the most commonly reported substance used in the past month was alcohol (43.6%), followed by cannabis (14.4%) and tobacco (12.4%). There were no significant group differences in use. 42.4% of all participants reported ever using cannabis in their lifetime, whereas 21.4% reported currently using cannabis. There were no group differences in ever having used cannabis. Regarding lifetime substance abuse disorders, cannabis use disorder (5.7%) and alcohol use disorder (4.5%) were the most common and more often reported in stage 1b participants relative to other groups. Furthermore, alcohol, cannabis and tobacco use remained relatively consistent at 6‐ and 12‐month follow‐ups when compared to baseline use. Conclusion: Alcohol was the most commonly used substance followed by cannabis and tobacco. Although substance use did not differ between those at different stages of risk, overall prevention strategies are still warranted for youth at‐risk for SMI, especially those who are more symptomatic and potentially at greater risk of developing an SMI. [ABSTRACT FROM AUTHOR]

Aim As early intervention in psychosis (EI) continues to develop, clinical governance maintains an important role in the 'real world' analysis of services. This paper details an audit of all discharges from a regional early intervention service in the United Kingdom, providing benchmarking information on service structure, interventions and outcomes. The background places the service in the context of national and international guidelines. Methods All discharges between service inception in 2004 and February 2011 were retrospectively examined and audited according to identified standards, based upon international and national guidelines. A total of 110 patients were discharged from the EI service after a period of involvement of at least 6 months. Results A high proportion of service users (55%) had their care transferred back to primary care after discharge. Physical health and social needs were well addressed, and almost half of individuals were in education, training or employment upon discharge. Most service users (69%) did not require inpatient admission during their involvement with the service. Although the majority had psychological, pharmacological and physical health needs addressed, there remained room for improvement when measured against identified standards. Conclusions This paper details outcomes of every patient seen by an EI service since inception, providing valuable benchmarking information for those involved in management of similar services, service redevelopment, commissioning, and implementation of evidence-based practice. The proportion of service users in education, training or employment after discharge exceeded expectations considerably. [ABSTRACT FROM AUTHOR]

Aims: There has been a surge in child mental health literacy training programmes for non‐mental health professionals. No previous review has examined the effectiveness of child mental literacy training on all professionals in contact with children. Methods: Studies were identified through a systematic literature search of the Cochrane, EMBASE, Medline, and PsycINFO databases in February 2019. The review included studies that delivered training to professionals who have regular contact with young people aged 0 to 19 in the context of their role and at least one component of mental health literacy; (a) knowledge, (b) attitudes, (c) confidence in helping, (d) intention to help and (e) actual helping behaviour. The quality of papers was reviewed using the Cochrane revised Risk of Bias Tool for randomized controlled trials (RCTs) and the Integrated Quality Criteria for the Review of Multiple Study Designs for non RCTs. Results: Twenty‐one studies met eligibility criteria (n = 3243). There was some evidence that global and specific child mental health literacy training improved professionals' knowledge and stigma‐related attitudes towards mental health. Few studies investigated the impact of training on actual helping behaviour. Conclusion: There may be value in providing child mental health literacy training to professionals in contact with children, however there is a need for studies to evaluate the long‐term impact of such training, particularly on subsequent access to appropriate support. Findings raise concerns about the quality of the studies reported in the systematic review and recommendations are made for future studies. [ABSTRACT FROM AUTHOR]