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Abstract Aims The specific and multifaceted service needs of young people have driven the development of youth-specific integrated primary mental healthcare models, such as the internationally pioneering headspace services in Australia. Although these services were designed for early intervention, they often need to cater for young people with severe conditions and complex needs, creating challenges in service planning and resource allocation. There is, however, a lack of understanding and consensus on the definition of complexity in such clinical settings. Methods This retrospective study involved analysis of headspace’s clinical minimum data set from young people accessing services in Australia between 1 July 2018 and 30 June 2019. Based on consultations with experts, complexity factors were mapped from a range of demographic information, symptom severity, diagnoses, illness stage, primary presenting issues and service engagement patterns. Consensus clustering was used to identify complexity subgroups based on identified factors. Multinomial logistic regression was then used to evaluate whether these complexity subgroups were associated with other risk factors. Results A total of 81,622 episodes of care from 76,021 young people across 113 services were analysed. Around 20% of young people clustered into a ‘high complexity’ group, presenting with a variety of complexity factors, including severe disorders, a trauma history and psychosocial impairments. Two moderate complexity groups were identified representing ‘distress complexity’ and ‘psychosocial complexity’ (about 20% each). Compared with the ‘distress complexity’ group, young people in the ‘psychosocial complexity’ group presented with a higher proportion of education, employment and housing issues in addition to psychological distress, and had lower levels of service engagement. The distribution of complexity profiles also varied across different headspace services. Conclusions The proposed data-driven complexity model offers valuable insights for clinical planning and resource allocation. The identified groups highlight the importance of adopting a holistic and multidisciplinary approach to address the diverse factors contributing to clinical complexity. The large number of young people presenting with moderate-to-high complexity to headspace early intervention services emphasises the need for systemic change in youth mental healthcare to ensure the availability of appropriate and timely support for all young people.

Introduction: Due to the significant burden associated with mental disorders that have their onset in youth, there is a critical need to improve treatments and treatment outcomes. Given the evidence for physical activity (PA) as an effective intervention for reducing depression and anxiety symptoms in young people, we examined young people's attitudes towards and acceptability of PA as part of mental health treatment, predictors of current engagement in PA and predictors of attitudes towards PA as a treatment option., Methods: Participants in this cross-sectional study were 88 young people (15-25 years) who were engaged in treatment at youth mental health services in Melbourne, Australia., Results: Young people's attitudes towards PA as a treatment option were generally positive. The acceptance of PA as a treatment option was predicted by fewer perceived barriers and more benefits to exercise, higher autonomous motivation and lower amotivation; whereas, the only significant predictor of current engagement in PA was autonomous motivation., Discussion: The integration of PA interventions within mental health treatment appears to be acceptable to young people; however, acceptance of PA as a treatment option is influenced by perceived barriers and benefits of PA and autonomous motivation. A focus on increasing autonomous motivation by enhancing the perceived value of PA and choosing preference-based, enjoyable activities may assist in addressing the complex range of factors that impact the ability of these young people to become more physically active. Addressing these factors may assist with implementing PA interventions within psychological treatments for mental disorders., (© 2021 John Wiley & Sons Australia, Ltd.)

Dual careers (DCs) are challenging trajectories followed by athletes willing to develop their academic/professional career with their athletic careers. These trajectories usually entail additional stressors, which can decrease athletes' mental health or even increase their risk of mental ill‐health. While existing research has recognized the importance of psychological and social factors in both of these areas separately, we lack systematic knowledge on which factors are associated with European DC athlete mental health outcomes, making evidence‐based practice more challenging. In this regard, to advance the European DC tradition and to provide a strong base for researchers and practitioners working within this field, this systematic review aims to appraise this evidence identifying and categorizing the psychological and social factors associated with the European DC athletes' mental health. We conducted this review according to Preferred Reporting for Systematic Reviews and Meta‐Analysis guidelines and performed the systematic search in six databases, finding 56 eligible articles. Our analysis identified 35 different psychological and social factors, most showing significant associations with athletes' mental health. Notably, affect, stress, motivational climate, mindfulness, resilience, perfectionism, goal orientation, motivation, and basic psychological need satisfaction showed the strongest evidence associated with mental health. Overall, this review provides a comprehensive synthesis of psychological and social factors, advancing the holistic ecological approach in dual careers and athlete mental health. Yet, our results highlight the need to strengthen the evidence regarding these factors and provide specific research avenues, such as focus on DC‐specific factors and consideration of DC athlete definition and career trajectories. Highlights: Our systematic review analyzed the psychological and social factors affecting European dual career (DC) athletes' mental health, yielding 56 relevant articles.We identified 35 distinct factors, organized into four psychological (Identity, Expectations, and Beliefs; Emotional and Affective Responses; Motivation and Goal‐oriented Behavior; and Competencies and Coping Resources) and three social categories (Sport and Academic Climates; DC‐Specific Demands; and Interactions with DC Agents). We narratively developed each category and synthesized the findings into a DC development environment working model.Our findings illustrate nine factors with the most robust associations with mental health. For future research, we emphasize the need for more detailed characterizations of DC athletes, deeper explorations of DC competencies, and a focus on longitudinal and replication studies to enhance our understanding of DC mental health in Europe. [ABSTRACT FROM AUTHOR]

Background: Integrated youth services are an emerging delivery model in Canada that addresses siloed and fragmented youth mental health and other services. Youth engagement is viable for developing integrated youth services when purposefully built. However, it is not always clear how youth are involved in service transformation as decision‐makers, and it requires an exploration of how to work with youth authentically and intentionally in the codesign process. Methods: This study reflects on the development of HOMEBASE, a network of integrated youth service delivery in Saskatchewan, Canada, and documents the process of actively and authentically engaging with youth through distributive leadership in the codesign process. Findings: Youth are actively and eagerly willing to participate in the codesign process of developing integrated services when there is a shared responsibility, and they are authentically involved and informed within the decision‐making process. This requires time to form trust, build relationships and provide youth with low‐pressure environments to foster healthy debates. Conclusion: By utilizing a distributive leadership approach, the Youth Codesign Team has been engaged in various levels of decision‐making. By following these guiding principles, policymakers, youth development workers and researchers can engage youth in meaningful ways to improve the design and development of integrated care. Patient or Public Contribution: Five youths from the HOMEBASE Provincial Youth Co‐Design Team collaborated in writing this article based on their experiences of being engaged at varying levels of decision‐making in a distributive leadership approach to building integrated youth services. [ABSTRACT FROM AUTHOR]

Rates of social, emotional, and behavioral difficulties are rising and significantly impact K-12 students' learning. Unfortunately, many teachers report being underprepared to identify, refer, or manage these symptoms. This study utilized a graduate course to address the mental health literacy needs of in-service teachers. Significant improvements in mental health literacy were achieved at course completion. Several participants also reported examples of how they demonstrated mental health literacy in their subsequent educational practices. These findings support the impact of in-service teacher education that focuses on mental health literacy. [ABSTRACT FROM AUTHOR]

Using data from the Pathways to Desistance Project, this study examined the bi-directional and longitudinal relationship between mental health symptoms and connectedness among 561 system involved Black youth. Higher mental health symptom scores at baseline increased connectedness scores one year later. Connectedness scores increased for two consecutive years until the transition to adulthood when participants were on average 19–20 years-old. During the transition to adulthood, mental health symptom scores worsened, highlighting the transition to adulthood as a key timepoint to administer supportive interventions addressing the mental health needs of Black youth who interact with the juvenile justice system. [ABSTRACT FROM AUTHOR]

Objective: Little is known about the co‐occurrence of nonsuicidal self‐injurious (NSSI) behaviors and eating disorder (ED) pathology in community samples of adolescents. Methods: A total of 1558 Norwegian upper secondary school students (Grades 11, 12, and 13) completed the Deliberate Self‐Harm Inventory and a measure of ED pathology. Results: Adolescents (53.1% F, 46.9% M) were a mean age of 17.1 years. A higher level of ED pathology was reported (12.1 vs. 5.3, p <.001) among adolescents who had a history of NSSI. Significantly higher levels of ED pathology were found among females who reported hitting themselves until bruised, head banging, severe scratching, and burning with a lighter, but not cutting, or the other forms of self‐injury. Of adolescents with a history of NSSI, 60% of females and 15% of males scored above a cutoff for ED pathology. Of adolescents scoring above a cutoff for ED pathology, 42.5% of females and 37.1% of males had engaged in lifetime NSSI. Discussion: Adolescents—in particular, females— with a history of NSSI reported significantly greater ED pathology. Notably, a higher proportion of males with ED pathology reported lifetime self‐injury than vice versa, underscoring the importance of carefully screening for the presence of self‐harm among males with ED pathology. Public Significance Statement: Over 1500 upper secondary school students with an average age of 17 years completed an online survey assessing current ED pathology and lifetime NSSI. Adolescents, particularly females, with a history of self‐harm reported significantly more ED pathology. Findings also indicated the need to carefully screen for self‐harm among males with ED pathology. Parents, schools, and health professionals should be aware that self‐harm and ED pathology commonly co‐occur and warrant assessment. [ABSTRACT FROM AUTHOR]

Teachers can play a crucial role in identifying and responding to children's mental health difficulties. This study explored teachers' mental health literacy (MHL) and their help-giving responses, a topic which is relatively unexplored, particularly at primary school level. Primary teachers (N = 356) responded to a questionnaire that followed the presentation of each of three vignettes: a non-clinical, control, vignette and two clinical vignettes. One of the clinical vignettes described a child with generalised anxiety disorder and another described a child with depression. Mixed-methods questioning was used to assess teachers' ability to recognise internalising disorders and their help-giving responses. Most participants were able to recognise a child experiencing an internalising disorder, with 84% accurately identifying anxiety and 71% accurately identifying depression. Multiple regression analyses showed that being female and having more exposure to mental illness were significantly associated with greater concern for affected children. Greater concern and confidence in one's ability to help students in need were significantly associated with teachers' intention to offer support. More years of teaching experience was associated with less help-giving intentions. MHL training for teachers is recommended so as to improve their ability to identify and respond to children's mental health difficulties in a timely manner. [ABSTRACT FROM AUTHOR]

Sexual and relationship needs of people with psychosis are generally overlooked despite established psychosocial benefits and reduced risk of relapse. Despite mental health professionals' reluctance to initiate conversations about sexuality and intimacy with service-users, people with psychosis and their support networks have indicated their desire for professionals to address intimate topics. Clinical psychologists are specifically trained to address complex psychological issues; however, no research to date has explored their views around discussing sexuality and intimacy. Q-methodology was used to explore clinical psychologists' personal and professional views about discussing sexuality and intimacy with people with psychosis. 27 clinical psychologists completed Q-sorts. Varimax rotation revealed three factors with distinct views; a majority perspective that highlighted the normality of sexuality and intimacy for people with psychosis and the acceptability of such conversations in clinical work for practitioners, a view focused on concerns about the appropriateness of discussing sexuality and the possibility that conversations could lead to increased risk, and a view that related to concerns about competency in addressing intimate subjects. The practical and clinical implications are discussed in terms of training need and limited access to sexual health services. [ABSTRACT FROM AUTHOR]

Background: The felt and emotional aspects of psychosis are poorly understood, however, their importance for the aetiology of, and recovery from, psychosis is increasingly accepted. Individuals experiencing psychosis often come into contact with mental health services during a crisis. Currently little is known about the emotional and felt aspects of this experience, yet this could support clinical intervention at this time. Aims: This research aims to gain an in-depth understanding of the lived, felt experiences of a first crisis in psychosis. Method: The study took a hermeneutic phenomenological perspective and utilised visual methods. Seven participants participated in idiographic, multi-modal interviews about their experiences. Results: Participants described their first crisis in psychosis as a shattering experience, entwined with their experiences of interpersonal trauma. In crisis, participants lost basic trust in the world; felt enveloped in a strange, threatening atmosphere, and lacked a sense of belonging. Conclusions: Attention to the felt aspects of a crisis indicate the existential, intersubjective and traumatic nature of the experience. Psychosocial, family and trauma-focused approaches that take into account the holistic, embodied and contextual nature of psychosis experiences seem best-placed to support treatment and research in this area. [ABSTRACT FROM AUTHOR]

There are well-documented situational factors which correspond to risks of exclusion and mental health difficulties. However, in education policy, factors relating to exclusion and mental health needs are often attributed to dispositional, within-person factors rather than situational factors, or even wider systemic factors which may contribute to the situations in which difficulties occur. There is also a great deal of evidence that the language of description has a significant impact on how issues are perceived and responded to. The following study aimed to explore the language used to describe concerns about children and young people's social, emotional and mental health needs on referral forms into a Local Authority SEND Support service. Thematic analysis identified a variation in how needs were described, including within themes of 'What?' the behaviour was, 'Why?' it was occurring and a 'So What?' factor in terms of implications. The following article concludes that the language used to describe behaviours causing concern can have an important impact on how the behaviours are framed, and therefore responded to, and argues for avoidance of language which predisposes within-person accounts of behaviours at the expense of the situational and systemic interpretations which need addressing in order to facilitate inclusive responses. [ABSTRACT FROM AUTHOR]

Background: headspace centres provide enhanced primary mental healthcare for young people. A priority is to provide services for all young people irrespective of a range of social disadvantages or social exclusion. The aims of this study were to: (i) delineate extent of social inclusion across domains of housing, studying/employment, functioning, alcohol, and other drug use; and (ii) map profiles of young people deemed vulnerable to experiencing additional barriers to accessing services based on their social inclusion domains (e.g., those living in unstable housing, not in employment/education, and/or experiencing intersecting or multiple forms of disadvantage or difficulties), including detailing their clinical characteristics. Methods: Young people were recruited from five headspace centres. Data relevant to social inclusion were examined. Multivariate logistic regression models were used to determine overlap between vulnerable groups, functional, social, clinical, and behavioural factors. Results: 1107 young people participated, aged 12–25 years (M = 18.1 years, SD = 3.3), most living in stable housing (96.5%) and engaged in studying/employment (84.8%). Specific vulnerabilities were evident in young people with NEET status (15.2%); in unstable accommodation (3.5%); of culturally diverse backgrounds (CALD) (12.2%); living in regional areas (36.1%); and identifying as lesbian, gay, bisexual, transgender, intersex, queer/questioning, and asexual plus (LGBTIQA+; 28.2%). Higher levels of distress, substance use, functional impairment, and lower social support were reported by those who were NEET and/or in unstable housing. LGBTIQA+ status was associated with high distress, depressive symptoms, and suicidal ideation. Conclusions: Most participants reported good social support, stable housing, and engagement in work or education. Those deemed vulnerable were likely to experience social exclusion across multiple domains and reported more mental health problems. The co-occurrence of mental ill-health and social exclusion highlights the importance of integrated mental healthcare. [ABSTRACT FROM AUTHOR]

Despite high rates of mental disorders in university students, very few seek professional help. University teaching staff are well placed to connect students with mental health care. However, little is known about university staff attitudes to and knowledge about mental health problems, or whether these factors influence their experience with and assistance of students with these problems. A total of 224 teaching staff members at the Australian National University, Canberra completed an anonymous online survey via an email link (16.4% response rate from N ~ 1370). Measures included demographic and professional information, experiences with student mental health, knowledge of depression (literacy) and attitudes to depression (stigma). Strength of stigmatising attitude did not predict whether a teaching staff member would approach a student to assist with mental health problems. Teaching staff with higher levels of depression literacy (OR = 1.14, p = 0.007) were more likely to feel sufficiently informed to help students with mental health problems. Ensuring staff complete mental health literacy training and have adequate skills to respond appropriately to students with mental health problems may help in connecting young people to appropriate care in a university context. [ABSTRACT FROM AUTHOR]

In Canada, it is estimated that 15-21% of youth have at least one diagnosable mental illness and less than one third access the mental health services they need. Social media (SM) may present a unique opportunity to promote mental health for young people. mindyourmind, a web-facilitated program with a comprehensive SM presence, was designed to raise awareness of mental health issues and improve access to services for youth dealing with mental health concerns. This article presents an evaluation of their SM strategies with the intent to better understand their influence on youth mental health literacy (MHL) and help-seeking behavior. [ABSTRACT FROM AUTHOR]

Family interventions in chronic psychosis are well established through systematic reviews and meta-analyses. Such reviews report that family intervention might reduce relapse and improve compliance with medication and reduction in levels of expressed emotion (EE). However, most of the previous research has been conducted in caregivers with chronic schizophrenia, and the effects of family interventions in the early stages are largely unknown. Using a quasi-experimental nonequivalent comparison group design, we evaluated the effectiveness of a 7-session group intervention among 59 caregivers of patients with first episode psychosis. Outcome variables measured were carers’ EE and social support. Carers were recruited from inpatient psychiatry units of a tertiary mental health center in South India. Follow-up assessments were carried out after one and three months of intervention. Descriptive and inferential statistics were applied to the data. Carers in the intervention group reported reduction of EE and improvements in social support at a one-month follow-up assessment. However, these benefits were not sustained at the three-month follow-up. Overall, both groups showed significant changes in all outcome variables over the time period. [ABSTRACT FROM PUBLISHER]

Post-Traumatic Stress Disorder (PTSD) is an extreme form of anxiety disorder following a traumatic event or experience with psychological affectation. It is a global psychosocial health issue facing people of all ages. It is also a source of concern for the families of the clients, their communities, and all the stakeholders involved in the management of this disorder. With more prevalence among women (10%) than men (4%), PTSD is of immense economic importance to the government, affected communities, and clients' families. In the military establishment in the United States, PTSD is a prominent feature among veterans who have returned home from long military postings and rotations overseas. The estimated two-year costs of treatment for combat-related PTSD are between $1.54 billion and $2.69 billion for the over 2 million troops involved in combat missions between 2001 and 2010. Solution-focused brief therapy (SFBT) models are some of the psychosocial approaches that have been utilized with some degree of success in the management of PTSD. This paper highlights the importance of SFBT in helping clients move towards the preferred future by concentrating on the present and focusing on their strengths and reachable goals. SFBT makes use of miracle questions, exception questions, coping questions, scaling questions, time-outs, problem-free talk, accolades, and tasks to identify the resources available to the client and aid their recovery from PTSD. Though there are some documented limitations, this form of intervention has been used by mental health professionals, with some successes in PTSD management. [ABSTRACT FROM AUTHOR]

Families play an important role in relapse-prevention following a person's first psychotic episode. To evaluate an open-ended family group intervention within a public adult mental health service, semi-structured interviews were conducted with: (1) carers who continually attended; (2) carers who attended once only; (3) carers who never attended; (4) case managers and (5) early psychosis clinicians. Benefits to group participation included: reduced isolation, sense of collective experience, opportunity to feel heard, reduced stigma and shame, increased knowledge about mental illness, and enhanced skills in supporting the care recipient. Barriers included: competing family and work commitments, applicability to own experiences of caring, discomfort with social situations and revealing and hearing emotions, and a belief that experiences are private. While attending the group increased knowledge, the benefits most emphasized were in the social connection with other carers and sharing one's story in a safe and reassuring environment. [ABSTRACT FROM AUTHOR]

There is increasing concern over the number of university students and university staff who require psychological support; however, little is known about the impact of this on higher education (HE) staff. University employees (n=91) from two UK universities completed an anonymous survey which explored their experience of providing support for psychological distress, receptiveness to mental health training and ability to recognise signs of mental health problems. A total of 63% of the sample reported providing support for psychological distress to students, and 41% had provided this service to colleagues. More than half of those without regular student contact had still provided support for psychological distress to students. Many staff were untrained (>70%) in the topic of mental health, and the majority of staff (64%) would welcome this form of training from employers if made available. HE staff participating in this research demonstrated ability to recognise the signs of schizophrenia (99%) and major depression (95%), but 37% of the sample confused everyday troubles with likely signs of a mental health difficulty. In conclusion, a large number of HE staff provide support for psychological distress as part of their workloads, though most are untrained to do so. HE institutions should ensure that appropriate mental health awareness training is made available to employees, and should encourage staff to complete this training if already available. [ABSTRACT FROM PUBLISHER]

Background: Qualitative investigations show that people can have positive and negative experiences of involuntary inpatient care. Legal changes have extended the use of compulsory treatment. Aims: To explore patients' perceptions of the impact of involuntary inpatient care on self, relationships and recovery. Method: Twelve participants were interviewed using a semi-structured interview schedule, exploring their experiences of involuntary inpatient care. Interviews were transcribed and analysed using a Thematic Analysis. Results: Participants reported varying experiences of involuntary inpatient care, with respect to perceived effects on self, relationships and recovery. Participants' perceptions of self were related to their experience of relationships with professionals. Perceived loss of competence and negative experiences of medication were seen as barriers to recovery. Conclusions: The development of caring and supportive relationships between ward staff/ mental health professionals and patients should be emphasized during involuntary inpatient care. Alternative forms of treatment should be routinely provided. [ABSTRACT FROM AUTHOR]

Background: There is at present scant data published on actual early psychosis intervention programmes and their development. Most studies have focused on duration of untreated psychosis and outcomes. Aims: We present the development of a programme based on a business model which would provide a reference for other locations planning to set up similar services, especially in situations of limited resources. Method: This is a descriptive paper of a programme which operates on the "Balanced Scorecard" model. The various interventions, assessments and outcomes of the programme were compared with a historical group of the precursor service. Results: A total of 747 patients were accepted. The key outcomes included an increase in those diagnosed with and treated for psychosis, and a fall in the duration of untreated psychosis. There was a change in the referral pattern: a higher proportion sought help on their own and a fall in police referrals. Compared to the historical group, the rates of antipsychotic polypharmacy and benzodiazepines prescriptions were significantly lower, and the treatment default rate was significantly lower. Conclusions: A public mental health programme based on a business model could attain good clinical outcomes as well as facilitate better accountability to the various stakeholders. [ABSTRACT FROM AUTHOR]

Background: High rates of remission are associated with effective treatments for first-episode psychosis (FEP). However, the goal of relapse prevention remains elusive for many remitted FEP patients. Aims: This paper describes the clinical and functional status of remitted FEP patients at a specialist service, and outlines the rationale and methodology of a randomized controlled trial of a multimodal relapse prevention therapy for these patients. Method: Eighty one remitted FEP patients and 63 of their family members attending the Early Psychosis Prevention and Intervention Centre (EPPIC) were randomized to treatment as usual (TAU) or to a relapse prevention therapy (RPT). Baseline data included demographics, Axis I and II diagnoses, psychiatric symptoms, functional status, and family distress, burden, and communication styles. Results: The findings indicated high rates of depressive and negative symptoms and substance abuse problems. Less than half of the patients had returned to employment. A high rate of depressive and anxiety symptoms was evident amongst family members, and burden was comparable to results from other FEP studies. Conclusions: FEP patients who reach remission have wide-ranging clinical and psychosocial needs. Relapse risk remains high, and relapse prevention is a critical priority. Family members also need specific interventions. Declaration of interest: This study described in this paper has been funded by an independent research grant from Eli Lilly via the Lilly Melbourne Academic Psychiatry Consortium. [ABSTRACT FROM AUTHOR]

Many individuals with schizophrenia have family members who are actively involved in their cure. Often, these family members feel burdened and experience significant distress as a consequence of this increased responsibility. Family interventions have been shown to reduce relapse in individuals with psychosis, highlighting the importance of the family component in psychosis treatment programs. This paper describes how an optimal family intervention can he devised using a recovery framework, and used within an early psychosis treatment program. Three-year outcome data is presented demonstrating improvement in family well-being, and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

The authors review the methodology and findings of economic evaluations of 42 community mental health care programs reported in the English-language literature between 1979 and 2003. There were three substantial methodological problems in the literature: costs were often not completely specified, the quality of econometric analysis was often low, and most evaluations failed to integrate cost and health outcome information. Well-conducted research shows that care in the community dominates hospital in-patient care, achieving better outcomes at lower or equal cost. It is less clear what types of community programs are most cost-effective. Future research should focus on identifying which types of community care are most cost effective and at what level of intensity they are most effective. [ABSTRACT FROM AUTHOR]

Background: Psychosis is most likely to occur during adolescence. This transition period is characterized by individuals becoming less reliant on family members, and more reliant on peers, for development and support. Little is understood about the specific nature of peer relationships in young people experiencing psychosis. Method: Twelve participants were interviewed about their peer experiences using a semi-structured interview schedule. Grounded theory was used to develop a "lifespan" model of peer relationships in childhood, and during early and later adolescence. Results: Family adversity and a mixture of positive and negative peer relationships emerged across the lifespan. There was, however, a bias towards more negative relationships. Three stages of development were identified. Conclusions: Early intervention programmes aimed at increasing resilience may enable young people to manage negative peer relationships in childhood and adolescence. Furthermore, mental health services may develop interventions aimed at maintaining and developing peer relationships in those recovering from a first episode of psychosis. Declaration of Interest: None [ABSTRACT FROM AUTHOR]

Objective Substantial delays in providing access to treatment in first-episode psychosis have been well documented. The present study examines the impact of strategies aimed at improving access and reducing delays. Method A pilot community education campaign was conducted with the aim of reducing the duration of untreated psychosis (DUP) in a geographically defined intervention sector located in the northwestern region of Melbourne, Australia. Utilising a quasi-experimental design, a comparison sector with similar demographics was selected from another part of the north-western region. A mobile early detection team and the same treatment system served both sectors. Results While there was no significant difference between the mean DUP for intervention and comparison sectors, the distributional features of DUP between the two regions were significantly different. In the intervention sector, disproportionately more cases with very long DUP were detected. When a small number of outliers were removed, the mean and median DUP in the intervention sector was reduced. Conclusion These findings highlight the complexity of treatment access and delay and suggest that efforts to reduce DUP may have two effects, not one. Firstly, a different sample of cases is treated through the detection of hidden ‘long DUP’ cases that otherwise may have remained untreated. Secondly, the DUP for the remainder may indeed be reduced. More research with larger samples and more potent campaign strategies is clearly required. It may also be worth considering whether there is a safe and ethical way to undertake a RCT of early versus delayed antipsychotic treatment to perhaps settle the DUP debate once and for all. [ABSTRACT FROM AUTHOR]

Group therapy for first episode of schizophrenia patients is examined for its effect on treatment compliance and dropout rates. Results from data collected over a two-year period on 77 patients in the first episode of schizophrenia show that there is a statistically significant link (p < .001, Fischer's Exact) between group participation and lowering the number of dropouts. Clinical case data is used to illustrate strategies for keeping patients in group and compliant with treatment. The statistical and the case data support the conclusion that group participation should be encouraged for patients in the first episode of schizophrenia. This report adds to an increasing awareness in the literature about the benefits of group treatment for schizophrenia. [ABSTRACT FROM AUTHOR]

Within the UK, it is envisaged that Early Intervention Services will be developed nation-wide by 2004 and these are expected to adhere to a strict model of service structure and provision. This uniform approach seems to lack the flexibility required to cater for local needs. Therefore, it would appear more appropriate to develop Early Intervention Services based on assessments of first-episode psychosis (FEP) within the context of the local mental health economy and current service provision. A survey of FEP cases within South and West London revealed that existing mental health services were unable to adequately provide specialist care to this client group. As a result, it was decided to set up a tertiary service to provide comprehensive care to FEP patients based within the community. This package comprises assertive engagement, intensive keyworker support, atypical antipsychotics, psychosocial interventions, specialist psychological treatments, occupational therapy and educational/vocational rehabilitation. An ongoing evaluation of this specially tailored service is being conducted, focussing on patient characteristics, pathways to care, service delivery, patient outcomes and patient, carer and referrer satisfaction. [ABSTRACT FROM AUTHOR]

Objectives A questionnaire was administered with an aim to assess the attitudes of mental health clinicians towards the adoption of an early intervention approach and to monitor attitudinal change during the introduction of this approach. Method The perceptions of Early Psychosis Intervention (PEPI) questionnaire was developed and then completed by clinicians at three time points over 4 years during the introduction of a best practice early intervention approach ( n=143, 178, 102, respectively). Results Indicate that at all three time points clinicians generally agreed with the potential advantages of early intervention but were unsure about their own readiness to implement such intervention. Responses to an open-ended question regarding concerns about the new approach indicated a positive shift up the developmental process of change, from initial concerns about personal skills, resources and workload, to a gradually more specific focus on particular aspects of clinical interventions and on the impact of the new approach. Conclusions Our services have introduced early psychosis intervention. Clinicians have moved up the developmental process of change. The questionnaire has provided a means for clinicians to influence the change process. [ABSTRACT FROM AUTHOR]

The self-organized house (SOH) is a resident structure with light outpatient assistance. We have had a long time experience of these structures in the rehabilitation treatment of chronic psychotics. Our more recent experience is to use these kind of structure for the early treatment, in the subacute phases. The patient is treated for several years, separated and protected from his family. Family therapy is started later. The flexibility of protection, therapies, and social committments allow a different perspective in the treatment of early psychosis. Several single cases, and study on a small sample group are presented. [ABSTRACT FROM AUTHOR]

The project aims to create a process model for dealing with mental health issues within secondary education. This will be achieved by creating clearer and more efficient pathways into appropriate care and equipping staff with the knowledge and skills to enable fast referral or to support young people within the educational institution. Initial components of the project include meeting with key individuals in schools, college and community to identify core issues in relation to the mental health of young people. Service mapping: youth services/projects within the city which may impact or be an added resource to the project through partnership working. Planning and delivery of training package (cascade model) to school/college staff. Development of a mental health promotion programme in partnership with NHS Mental Health Promotion Department. Development of referral procedures: mental health practitioner and educational psychologists attending in school resource meetings in consultancy capacity with referral onto appropriate agency if necessary. Piloting of referral and screening tools within educational establishments. Progress of the above as well as current and future developments will be discussed. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess young people's mental health literacy in relation to psychosis and depression. It forms part of the baseline measure for the evaluation of a community awareness campaign called The Compass Strategy. A cross-sectional telephone survey using structured interviews was conducted. Vignettes of a person with either depression or psychosis were presented. The randomly selected sample was comprised of 1207 young people aged 12-25 from Melbourne and surrounding rural areas. Overall depression was far more frequently correctly identified than psychosis. A significantly higher proportion of females were able to correctly identify depression and psychosis. Counsellors, family members and friends were the preferred source of help overall followed by General Practitioners and Psychiatrists. However, there were significant differences between disorders in ranking of these sources of help. Vitamins and herbal treatments were rated as more helpful than antidepressants and antipsychotics. To increase early recognition of mental illness by the general public, efforts need to focus on improving knowledge of both signs and symptoms, and effectiveness of treatments. Family, friends and young males are particularly important targets. [ABSTRACT FROM AUTHOR]

For the past 3 years, the Canadian Mental Health Association (CMHA), a national voluntary organization, has coordinated an early psychosis intervention project intended to raise awareness, enhance family coping skills and promote the availability of and access to appropriate early psychosis services across Canada. Funded by Health Canada, this project has achieved breadth and depth of impact through Canada-wide networking and dissemination of resource materials coupled with targeted local-level activities at three CMHA sites. With a strong orientation toward increasing community capacity to understand, identify and respond to first episode psychosis, project activities have included: creating and broadly distributing print materials in English and French (hard copy and web) conducting educational workshops with community members and gatekeepers identifying advocacy opportunities and pursuing advocacy initiatives regarding policy and practice and supporting the development of first episode family networks across Canada and with them, creating and disseminating innovative family support resource materials. This poster session will present the process, products and outcomes of the project which can serve as a valuable model of a national level initiative and its evolution. [ABSTRACT FROM AUTHOR]

Data from the New York High-Risk Project were used to study prodromal symptoms in subjects age 9, years before some of them developed psychotic disorders. We rated thought disorder from videotaped interviews (total n=123). Previous analyses showed elevated scores in subjects with adulthood schizophrenia-related psychosis ( n=9), a group including individuals with schizophrenia (Sz, n=4) and schizoaffective disorder, mainly Sz (SAS, n=5). However, high scores were observed primarily in subjects with SAS. To examine whether there is an association of thought disorder with psychosis in combination with affective disturbance, we examined means of three patients with adulthood affective psychosis (AffP), and found that none exhibited thought disorder in childhood. Thus, thought disorder was not present in subjects with AffP, moderately so in those with Sz, and high in those with SAS. An interpretation of these results seems, considering the sample sizes, speculative, in spite of statistical significance. We were able to expand the sample to total n=255, with adulthood SRP n=14, and AffP n=9. We will present these analyses and further discuss thought disorder prior to affective and schizophrenia-related psychosis. [ABSTRACT FROM AUTHOR]

The realization of early detection and intervention programs needs to combine the preexisting mental health servicesorganization on the territory with modalities specific for professionals' competence, setting, procedures and attitude. Actually, services mostly function with current standard practices and professionals having different backgrounds: then they could be operatively and culturally revitalized by the link with a more focused, outreaching and research-oriented working style. The authors describe the organizational strategies to overcome the problems of connecting an ad hoc early detection and intervention Service, set up on a STAR-SHAPED MODEL, the core of which is a team acquired by counselling contracts, with the existing network of Psychiatric Services (4 CMHC, 2 Psychiatric Wards, 1 day Centre, 2 Residential Facilities) and Agencies of the area (GPs, Child Neuropsychiatry, Schools, etc.). In the next 3-year period (2002-2005) the increase of cases and the enlargement of the catchment area, making the system more complex, will require further adaptation and improvement of the model. [ABSTRACT FROM AUTHOR]

We will present the demographics, quality of life, and illness characteristics of a group of patients with new-onset psychosis, assessed by the Early Detection and Intervention Programme of Psychosis (EDIPP), initiated 1 year ago by the Massachusetts Department of Mental Health (DMH), Southeastern Area. The EDIPP is conducted by the crisis team, which includes clinicians, nurses, and psychiatrists and serves a population of approximately half a million people. Patients diagnosed with new-onset psychosis (according to preset criteria) are referred for assessments, using the premorbid, quality of life, psychiatric, and cognitive evaluations. Up to 60% of patients cooperated with the follow up visits. A significant number of new-onset psychotic patients (up to 50%), however, could not be contacted by staff for follow-up, because during the crisis evaluation were sent to facilities outside the geographical area. Patients who cooperated with the follow-up appointments had significant support in the community,especially families who understood their illness. The high likelihood of noncompliance in patients with new-onset psychosis points to the need of integrated programmes that will address education and antistigma efforts in the community and provide sufficient therapeutic support. Such a programme needs to be based on a case-management system and cannot be successfully accomplished as part of an academic or private endeavour alone outside DMH guidelines. [ABSTRACT FROM AUTHOR]