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Adolescent Precursors to Psychiatric Disorders – Learing from Analysis of User-Service Engagement

Mid-Term Report Summary - APPLAUSE (Adolescent Precursors to Psychiatric Disorders – Learing from Analysis of User-Service Engagement)

Low levels of access to and participation in mental health care across the world have been widely reported. Access to treatment could have a significant impact on young people for whom mental health problems are emerging and at a time in the life course when problems could impact opportunities for education and thus lead to foregone education and employment prospects. The APPLAUSE (Adolescent Precursors to Psychiatric Disorder Learning from User Service Engagement) project analyses current access models, reports of individual experiences of positive and negative interactions with health care services and the culturally embedded social factors that impact on such access among young people in England and in Brazil. Over the first half of the project we have been progressing toward our overarching aim of understanding the relationship between mental health trajectories and access to care and social support and the individual and contextual factors which may impact on them in Brazil and England. Moreover, due to recent transitions in the socio-economic context in both countries (we now have mental health data collected prior to and during macroeconomic recessions in Brazil and the UK) our data could also provide a window into what happens in relation to burden of mental health problems and demand for services during times of economic shock in both high income and middle income countries.

Among two ongoing prospective community cohorts which have already completed baseline evaluations of mental health status, we have now collected two additional waves of data from almost 400 young people in the UK and the first wave of data from 1,500 young people in Brazil. Initial findings suggest that low levels of awareness and stigmatising attitudes among both parents and young people act as barriers to early help-seeking and service use for mental health problems. As part of this assessment, we have developed, validated and applied a new measure entitled SELF-I (Self-identification of mental illness scale) which assesses young people’s perceptions of their own mental health / illness. Further analysis will explore additional socioeconomic and clinical barriers to service use and the persistence and / or stability of these findings over time in addition to their relative economic impact. In addition to documenting service use patterns and identifying key barriers and facilitators to improve access to care, we are also using our initial findings, to develop a pilot intervention which examines how we can improve access to mental health care for this vulnerable group of young people who experience mental health problems. The intervention will be delivered via a mobile app which facilitates access to mental health services and treatments for adolescents and young adults (aged 16-25 years) with mental health problems.