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      Transforming youth mental health services in a large urban centre: ACCESS Open Minds Edmonton

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          Abstract

          Aim

          This paper outlines the transformation of youth mental health services in Edmonton, Alberta, a large city in Western Canada. We describe the processes and challenges involved in restructuring how services and care are delivered to youth (11‐25 years old) with mental health needs based on the objectives of the pan‐Canadian ACCESS Open Minds network.

          Methods

          We provide a narrative review of how youth mental health services have developed since our engagement with the ACCESS Open Minds initiative, based on its five central objectives of early identification, rapid access, appropriate care, continuity of care, and youth and family engagement.

          Results

          Building on an initial community mapping exercise, a service network has been developed; teams that were previously age‐oriented have been integrated together to seamlessly cover the age 11 to 25 range; early identification has thus far focused on high‐school populations; and an actual drop‐in space facilitates rapid access and linkages to appropriate care within the 30‐day benchmark.

          Conclusions

          Initial aspects of the transformation have relied on restructuring and partnerships that have generated early successes. However, further transformation over the longer term will depend on data demonstrating how this has impacted clinical outcomes and service utilization. Ultimately, sustainability in a large urban centre will likely involve scaling up to a network of similar services to cover the entire population of the city.

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          Integrated (one-stop shop) youth health care: best available evidence and future directions.

          Sarah E. Hetrick, Alan Bailey, Kirsten E. Smith … (2017)
          Although mental health problems represent the largest burden of disease in young people, access to mental health care has been poor for this group. Integrated youth health care services have been proposed as an innovative solution. Integrated care joins up physical health, mental health and social care services, ideally in one location, so that a young person receives holistic care in a coordinated way. It can be implemented in a range of ways. A review of the available literature identified a range of studies reporting the results of evaluation research into integrated care services. The best available data indicate that many young people who may not otherwise have sought help are accessing these mental health services, and there are promising outcomes for most in terms of symptomatic and functional recovery. Where evaluated, young people report having benefited from and being highly satisfied with these services. Some young people, such as those with more severe presenting symptoms and those who received fewer treatment sessions, have failed to benefit, indicating a need for further integration with more specialist care. Efforts are underway to articulate the standards and core features to which integrated care services should adhere, as well as to further evaluate outcomes. This will guide the ongoing development of best practice models of service delivery.
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            Youth Mental Health Should Be a Top Priority for Health Care in Canada

            Ashok Malla, Jai Shah, Srividya Iyer … (2018)
            In this article we have provided a perspective on the importance and value of youth mental health services for society and argued that advancing youth mental health services should be the number one priority of health services in Canada. Using the age period of 12–25 years for defining youth, we have provided justification for our position based on scientific evidence derived from clinical, epidemiological and neurodevelopmental studies. We have highlighted the early onset of most mental disorders and substance abuse as well as their persistence into later adulthood, the long delays experienced by most help seekers and the consequence of such delays for young people and for society in general. We have also provided a brief review of the current gross inadequacies in access and quality of care available in Canada. We have argued for the need for a different conceptual framework of youth mental disorders as well as for a transformation of the way services are provided in order not only to reduce the unmet needs but also to allow a more meaningful exploration of the nature of such problems presenting in youth and the best way to treat them. We have offered some ideas based on previous work completed in this field as well as current initiatives in Canada and elsewhere. Any transformation of youth mental health services in Canada must take into consideration the significant geographic, cultural and political diversity across the provinces, territories and indigenous peoples across this country.
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              Canadian response to need for transformation of youth mental health services: ACCESS Open Minds (Esprits ouverts)

              Ashok Malla, Srividya Iyer, Jai Shah … (2018)
              Aim Youth mental health is of paramount significance to society globally. Given early onset of mental disorders and the inadequate access to appropriate services, a meaningful service transformation, based on globally recognized principles, is necessary. The aim of this paper is to describe a national Canadian project designed to achieve transformation of mental health services and to evaluate the impact of such transformation on individual and system related outcomes. Method We describe a model for transformation of services for youth with mental health and substance abuse problems across 14 geographically, linguistically and culturally diverse sites, including large and small urban, rural, First Nations and Inuit communities as well as homeless youth and a post‐secondary educational setting. The principles guiding service transformation and objectives are identical across all sites but the method to achieve them varies depending on prevailing resources, culture, geography and the population to be served and how each community can best utilize the extra resources for transformation. Results Each site is engaged in community mapping of services followed by training, active stakeholder engagement with youth and families, early case identification initiatives, providing rapid access (within 72 hours) to an assessment of the presenting problems, facilitating connection to an appropriate service within 30 days (if required) with no transition based on age within the 11 to 25 age group and a structured evaluation to track outcomes over the period of the study. Conclusions Service transformation that is likely to achieve substantial change involves very detailed and carefully orchestrated processes guided by a set of values, principles, clear objectives, training and evaluation. The evidence gathered from this project can form the basis for scaling up youth mental health services in Canada across a variety of environments.
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                Author and article information

                Contributors
                Adam Abba‐Aji:
                ORCID: https://orcid.org/0000-0003-0369-4768
                abbaaji@ualberta.ca
                Journal
                Journal ID (nlm-ta): Early Interv Psychiatry
                Journal ID (iso-abbrev): Early Interv Psychiatry
                Journal ID (doi): 10.1111/(ISSN)1751-7893
                Journal ID (publisher-id): EIP
                Title: Early Intervention in Psychiatry
                Publisher: Wiley Publishing Asia Pty Ltd (Melbourne )
                ISSN (Print): 1751-7885
                ISSN (Electronic): 1751-7893
                Publication date (Electronic): 27 June 2019
                Publication date (Print): June 2019
                Volume: 13
                Issue: Suppl Suppl 1 , ACCESS Open Minds: Transforming Youth Mental Health Services Across Canada ( doiID: 10.1111/eip.2019.13.issue-S1 )
                Pages: 14-19
                Affiliations
                [ 1 ] Alberta Health Services Edmonton Zone Edmonton Alberta Canada
                [ 2 ] Department of Psychiatry University of Alberta Edmonton Alberta Canada
                [ 3 ] ACCESS Open Minds Edmonton Edmonton Alberta Canada
                [ 4 ] ACCESS Open Minds (Pan‐Canadian Youth Mental Health Services Research Network) Douglas Mental Health University Institute Montreal Quebec Canada
                [ 5 ] School of Rehabilitation, Faculty of Medicine l'Université de Montréal Montreal Quebec Canada
                [ 6 ] Department of Psychiatry McGill University Montreal Quebec Canada
                [ 7 ] Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM) Montreal Quebec Canada
                [ 8 ] Prevention and Early Intervention Program for Psychosis (PEPP) Douglas Mental Health University Institute Montreal Quebec Canada
                Author notes
                [*] [* ] Correspondence

                Dr. Adam Abba‐Aji, Department of Psychiatry, University of Alberta, 1E7 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, Alberta, T6G 2B7, Canada.

                Email: abbaaji@ 123456ualberta.ca

                Author information
                https://orcid.org/0000-0003-0369-4768
                https://orcid.org/0000-0002-7501-5018
                https://orcid.org/0000-0001-5367-9086
                https://orcid.org/0000-0002-7549-6990
                Article
                Publisher ID: EIP12813
                DOI: 10.1111/eip.12813
                PMC ID: 6771682
                PubMed ID: 31243911
                SO-VID: 0c2739d8-32da-416b-83b1-6552ce817cc0
                Copyright © © 2019 The Authors Early Intervention in Psychiatry Published by John Wiley & Sons Australia, Ltd
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 0, Tables: 2, Pages: 6, Words: 4873
                Funding
                Funded by: Canadian Institutes of Health Research
                Funded by: Graham Boeckh Foundation
                Categories
                Subject: Supplement Article
                Subject: ACCESS Open Minds: Transforming Youth Mental Health Services Across Canada
                Subject: Supplement Articles
                Custom metadata
                source-schema-version-number 2.0
                component-id eip12813
                cover-date June 2019
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.9 mode:remove_FC converted:01.10.2019

                Keywords: access,case identification,service transformation,youth mental health,canada
                Data availability:
                Keywords: access, case identification, service transformation, youth mental health, canada

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