Towards early intervention for youth mental health in primary care: a mixed methods investigation

In Ireland, psychological morbidity has been reported in 21-27% of young people and recent data has indicated that the youth suicide rate in Ireland is now the second highest (of 26 countries) in the European Union, for 0-19 year olds. Early intervention in youth mental health is increasingly viewed as easier, cheaper and more effective than traditional approaches to care. GPs, as the health care professional most often consulted by young people, have a central role in early detection of youth mental health and substance use problems. However, there is a dearth of evidence regarding the experiences and attitudes of young people and health care workers towards screening and treatment for mental and substance use disorders in primary care in Ireland. The overarching aim of this thesis was to examine the role of primary care (with a particular focus on the role of the GP) in providing early intervention and treatment for mental health and substance use problems in young people. It was a mixed methods study that involved qualitative interviews with health care workers (n=37) and young people (n=20) from primary care, secondary care and community agencies in two of Ireland’s most socio-economically disadvantaged areas, Limerick City and Dublin South Inner City and a national cross-sectional survey of GPs (n=175). The research found that while addressing youth mental health problems was a priority for most participants, a number of barriers to the identification and management of such issues were identified: access to services, flaws in traditional mental health services for young people under eighteen years, fragmentation between services and limited resources. The research outlined potential implications for clinical practice, research and education such as promoting awareness of mental health and the role of the GP in helping these issues, education of practitioners and improving access to psychological treatments for young people.