Objective: The aim of this paper is to describe the establishment of an integrated young person ’s mental health service and the findings of a qualitative evaluation conducted 2 years after its establishment. Method: A qualitative evaluation of the service was undertaken using a semi-structured interview, a service satisfaction survey and partnership analysis tool. Results: The major problems encountered in establishing the service were insufficient recognition of the cultural challenges in working together, difficulty in recruiting general practitioners, establishing a youth friendly environment and maintaining the quality of the relationship between partners. Conclusion: Despite almost 3 years of preparation, many important aspects of change management were underestimated or inadequately attended to.

This discussion paper outlines our personal views for debate on some of the complexities inherent in the crucial task of improving mental health services for young people in the UK.

Despite the evidence showing that young people aged 12–25 years have the highest incidence and prevalence of mental illness across the lifespan, and bear a disproportionate share of the burden of disease associated with mental disorder, their access to mental health services is the poorest of all age groups. A major factor contributing to this poor access is the current design of our mental healthcare system, which is manifestly inadequate for the unique developmental and cultural needs of our young people. If we are to reduce the impact of mental disorder on this most vulnerable population group, transformational change and service redesign is necessary. Here, we present three recent and rapidly evolving service structures from Australia, Ireland and the UK that have each worked within their respective healthcare contexts to reorient existing services to provide youth-specific, evidence-based mental healthcare that is both accessible and acceptable to young people.

For developmental as well as epidemiological reasons, young people need youth-friendly models of primary care. Over the past two decades, much has been written about barriers faced by young people in accessing health care. Worldwide, initiatives are emerging that attempt to remove these barriers and help reach young people with the health services they need. In this paper, we present key models of youth-friendly health provision and review the evidence for the effect of such models on young people ’s health. Unfortunately, little evidence is available, since many of these initiatives have not been appropriately assessed. Appropriate controlled assessments of the effect of youth-friendly health-service models on young people ’s health outcomes should be the focus of future research agendas. Enough is known to recommend that a priority for the future is to ensure that each country, state, and locality has a policy and support to encourage provision of innovative and well assessed youth-friendly services.

Objective Although schools are identified as critical for detecting youth mental disorders, little is known about whether the number of mental health providers and types of resources that they offer influence student mental health service use. Such information could inform the development and allocation of appropriate school-based resources to increase service use. This article examines associations of school resources with past-year mental health service use among students with 12-month DSM-IV mental disorders. Method Data come from the U.S. National Comorbidity Survey Adolescent Supplement (NCS-A), a national survey of adolescent mental health that included 4,445 adolescent–parent pairs in 227 schools in which principals and mental health coordinators completed surveys about school resources and policies for addressing student emotional problems. Adolescents and parents completed the Composite International Diagnostic Interview and reported mental health service use across multiple sectors. Multilevel multivariate regression was used to examine associations of school mental health resources and individual-level service use. Results Nearly half (45.3%) of adolescents with a 12-month DSM-IV disorder received past-year mental health services. Substantial variation existed in school resources. Increased school engagement in early identification was significantly associated with mental health service use for adolescents with mild/moderate mental and behavior disorders. The ratio of students to mental health providers was not associated with overall service use, but was associated with sector of service use. Conclusions School mental health resources, particularly those related to early identification, may facilitate mental health service use and may influence sector of service use for youths with DSM disorders.

Because the majority of children with mental health needs are most likely to receive treatment in a school setting, there is a long history of linking child and adolescent psychiatrists to schools. Psychiatrists traditionally have been involved in assessing, diagnosing, and treating the severely mentally ill or consulting with school-based providers. With no end in sight to the dearth of child and adolescent psychiatrists, not to mention child and adolescent behavioral health providers in other disciplines, this role has been broadened in recent years by several programs in which the child and adolescent psychiatrist provides flexible, population-based, systemic, and context-specific approaches to working in schools. In this article, the authors first review some of the traditional roles for child and adolescent psychiatrists working in school mental health settings. Then 2 national programs are highlighted, which successfully integrate psychiatrist trainees into comprehensive school mental health programs. The theoretical approach to a specific community-oriented, strengths-based model for school mental health support used in New Mexico by the University of New Mexico (UNM) Psychiatry Department ’s Center for Rural and Community Behavioral Health school telepsychiatry program, which supports rural and frontier school mental health programs and school-based health centers, is discussed in detail. The UNM model involves a strength-and resiliency-based collaboration between the child and adolescent psychiatrist, students, families, educators, and those who support them. The psychiatrist co-creates a “community of concern” and support for students, including not only customary participants such as parents, educators, and health care providers but also peers, families of choice, lay professionals, community gatekeepers, and others identified by the student as critical to his or her well-being. The advantages for child and adolescent psychiatry trainees being exposed to a wider variety of potential roles working with schools are also discussed.

Background: This paper describes a primary care-based clinical psychology service operating in an inner London borough that provides psychological intervention for children with emotional or behavioural difficulties and their families, and consultation and support to the primary health care teams. Method: A comparison is made with a local secondary level child mental health service in terms of characteristics of referrals and clinical outcome. Referrers’ perceptions of the primary care-based service are described. Results and Conclusions: The findings demonstrate a useful child and adolescent mental health service for children and adolescents with a broad range of childhood difficulties within a primary care setting, which appears to overcome some of the problems often associated with referral to secondary level services.

This article describes the development of the primary mental health worker (PMHW) role within Child and Adolescent Mental Health Services (CAMHS) within the UK, and focuses on services in Leicester, Leicestershire and Rutland, an area with a general population of 900,000. The concept behind the PMHW role is described and the application of this to practice is outlined. The role consists of consultation, liaison, direct work and training. The described primary mental health team comprises 13 PMHWs and is an integral part of a comprehensive CAMHS. Its aim is to support and enable primary care professionals in their work with mental health issues in children and families, thus promoting early recognition and management of child mental health problems and filtering appropriate referrals for specialist CAMHS intervention.