Assessment of mental health difficulties in children and young people in care attending a specialist mental health service

The purpose of this study is to test the validity of the Assessment Checklist measures in assessing complex mental health and behavioural difficulties of children and young people in care attending a specialist mental health service in Queensland, Australia. Fifty-eight consumers (53% male) with an average age of 8 years were assessed by carers on the Assessment Checklist for Children—Short Form and Strengths and Difficulties Questionnaire, and 44 consumers (36% male) with an average age of 13 years were assessed by carers on the Assessment Checklist for Adolescents—Short Form and Strengths and Difficulties Questionnaire. Results showed that the Assessment Checklist for Children—Short Form total score correlated with the Strengths and Difficulties Questionnaire total score. There were some correlations between subscales on both the measures. The Assessment Checklist for Adolescents—Short Form and Strengths and Difficulties Questionnaire correlated on very few domains. Domains of the Assessment Checklist measures that assess emotional dysregulation, trauma, interpersonal/attachment styles, sexual behaviour and food maintenance appear to provide additional clinical information about consumers that the standard Child and Youth Mental Health Service carer-report measure (Strengths and Difficulties Questionnaire) does not. It is recommended that the Assessment Checklist measures be used as an additional measure to assess the complexity of the children and young people in care who attend specialist mental health services.

The development and implementation of a peer support model for a specialist mental health service for older people: lessons learned

Purpose There has been a significant growth in the employment of peer workers over the past decade in youth and adult mental health settings. Peer work in mental health services for older people is less developed, and there are no existing peer work models for specialist mental health services for older people in Australia. The authors developed and implemented a peer work model for older consumers and carers of a specialist mental health service. The purpose of this paper is to describe the model, outline the implementation barriers experienced and lesson learned and comment on the acceptability of the model from the perspective of stakeholders. Design/methodology/approach To ensure the development of the peer work model met the needs of key stakeholders, the authors adopted an evaluation process that occurred alongside the development of the model, informed by action research principles. To identify stakeholder preferences, implementation barriers and potential solutions, and gain insight into the acceptability and perceived effectiveness of the model, a range of methods were used, including focus groups with the peer workers, clinicians and steering committee, consumer and carer surveys, field notes and examination of project documentation. Findings While the model was overall well received by stakeholders, the authors experienced a range of challenges and implementation barriers, in particular around governance, integrating the model into existing systems, and initial resistance to peer work from clinical staff. Originality/value Older peer workers provide a valuable contribution to the mental health sector through the unique combination of lived experience and ageing. The authors recommend that models of care are developed prior to implementation so that there is clarity around governance, management, reporting lines and management of confidentiality issues.

Between a rock and a softer place—A discourse analysis of helping cultures in crisis resolution teams

Crisis resolution teams are a community-based service, targeting adults experiencing acute mental health crises. The rationale for the development of crisis resolution teams is both value and efficacy-based: crisis resolution teams should contribute to the humanizing of mental health services and to enhanced efficacy. This diversity in purpose appears to affect the practices of help that are offered by crisis resolution teams, which research has shown to vary greatly. A discursive approach recognizes that practices are shaped by external paradigms and structures, and clinicians’ construction of professional identities and practices through their talk and meaning making. Thus, this study used a discursive psychological approach to identify discourses through which crisis resolution team clinicians talk about and understand helpful help in mental health crises. Focus group interviews with clinicians from eight crisis resolution teams revealed two broad and contradictory discourses: helpful help as something “made” with crisis resolution team workers as creators of collaborative and innovative practices, and helpful help as something “given” with the crisis resolution team workers as representatives of a predefined specialist mental health service culture. The contradictions between these discourses reflect the diverse rationale for the development of crisis resolution teams and the possible tensions and pressures under which crisis resolution team work is conducted. In this overall context, the study further critically examined the tensions between the discourse of constructing new practices, and existing practices constituted by the specialist mental health services’ traditional discourse. Failing to constantly reflect upon and question these tensions in collaboration with service users, carers, and other services can impair creativity and the development of humanizing helpful help.

Provision of neuropsychiatry services: variability and unmet need

Aims and methodNeuropsychiatry services remain underdeveloped and underprovided. Previous studies have shown variability in service provision in the UK. In this survey we approached all mental health and neuropsychiatric service providers within London to map current neuropsychiatric service provision and explore perceived barriers.ResultsAll the specialist mental health service providers responded. There was huge variability in neuropsychiatric service provision within different parts of London. There was evidence of significant unmet need and variability in service pathways. Lack of earmarked funds for neuropsychiatry and disjointed funding stream for such services were identified by providers as a barrier.Clinical implicationsThis study provides further evidence of an ongoing lack of adequate neuropsychiatric service provision. Reasons for variability and unmet need are discussed. Adoption of a previously proposed hub-and-spoke model of service provision and the removal of commissioning barriers through uniform national commissioning may help deal with this problem.

Patterns of Current Comorbidity in Young Help-Seekers: Implications for Service Planning and Delivery

Objective: To identify the pattern of current comorbidity in young help-seekers referred to a specialist mental health service. Method: One hundred and forty-nine participants were assessed for current psychiatric diagnoses following their referral to ORYGEN Youth Health. Results: Seventy-eight per cent of the sample rated for at least one diagnosis with almost half the sample presenting with two or more disorders. Next to comorbid depression and anxiety, comorbidity between substance use disorders and mood and anxiety disorders was the most prominent pattern of comorbidity in the sample. Conclusions: The present findings suggest that integration between mental health and substance abuse services is well overdue and must be addressed at policy, service system and clinical levels.

The PAS–ADD Checklist: independent replication of its psychometric properties in a community sample

BackgroundThe development of reliable, valid measures of psychopathology in people with intellectual disabilities is an important task. However, independent replication studies are rarely reported.AimsTo report data on the psychometric properties of the Psychiatric Assessment Schedule for Adults with Developmental Disabilities (PAS–ADD) Checklist.MethodThe PAS–ADD Checklist was completed for 226 adults as part of the assessment process for a specialist mental health service for people with intellectual disabilities.ResultsInternal consistency was acceptable. Factor analysis revealed one main factor that was characterised by items related to mood. The Checklist was sensitive to differences between diagnostic groups and had an overall sensitivity of 66%; its specificity was 70%.ConclusionsThe PAS–ADD Checklist is a quick and easy to use screening tool. Although at present it is the best measure available, it should not be the only method used to identify psychiatric disorders in people with intellectual disabilities.