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Many youths with attention‐deficit/hyperactivity disorder (ADHD) experience significant long‐term impairment and may develop concurrent mental and somatic health difficulties as adults. This is associated with burden and costs for the individual and society which could be prevented through continued support in youth. Yet, only few young people transition to adult mental health services for ongoing care in different countries worldwide. We provide an overview on current transition practices, highlighting the gaps in knowledge and the barriers to effective service transitioning, while considering the large geographical variation in available guidelines and service provision. For ease of use, this review is organized in a question‐and‐answer format covering different aspects of the transition process and considering both service users' and clinicians' perspectives. Consensus is needed to identify those that require continued care, the optimal timing to arrange transition, and the most suitable services. Finally, we discuss cost‐effectiveness of transition practices, consider examples of best practice, and propose recommendations on how to improve transitional care, including the importance of service users' input into transition planning. [ABSTRACT FROM AUTHOR]

Aim: Over the past two decades, the youth mental health field has expanded and advanced considerably. Yet, mental disorders continue to disproportionately affect adolescents and young adults. Their prevalence and associated morbidity and mortality in young people have not substantially reduced, with high levels of unmet need and poor access to evidence‐based treatments even in high‐income countries. Despite the potential return on investment, youth mental disorders receive insufficient funding. Motivated by these continual disparities, we propose a strategic agenda for youth mental health research. Method: Youth mental health experts and funders convened to develop youth mental health research priorities, via thematic roundtable discussions, that address critical evidence‐based gaps. Results: Twenty‐one global youth mental health research priorities were developed, including population health, neuroscience, clinical staging, novel interventions, technology, socio‐cultural factors, service delivery, translation and implementation. Conclusions: These priorities will focus attention on, and provide a basis for, a systematic and collaborative strategy to globally improve youth mental health outcomes. [ABSTRACT FROM AUTHOR]

Aim: Mental health‐related stigma is considered a significant barrier to help‐seeking and accessing care in those experiencing mental illness. Long duration of untreated psychosis is associated with poorer outcomes. The impact of stigma on the duration of untreated psychosis, in first‐episode psychosis remains unexplored. To examine the association between mental health‐related stigma and access to care in people experiencing first‐episode psychosis in Birmingham, UK. Methods: We collected data on a prospective cohort of first‐episode psychosis. The Stigma Scale was used as a measure of mental health‐related stigma, and duration of untreated psychosis as a measure of delay in accessing care. We performed logistic and linear regression analyses to explore the relationship between mental health‐related stigma and duration of untreated psychosis, adjusting for sex, age, educational level, religion and ethnicity. Results: On the 89 participants included in this study, linear regression analysis revealed that overall stigma and the discrimination sub‐factor were significant predictors of longer duration of untreated psychosis, whereas logistic regression identified the disclosure sub‐factor to be a significant predictor of longer duration of untreated psychosis. Conclusions: These findings demonstrate that stigmatizing views of mental illness from the patient's perspectives can result in delayed access to care. This emphasizes the importance of tackling mental health‐related stigma to ensure early treatment and improved outcomes for people experiencing first‐episode psychosis. [ABSTRACT FROM AUTHOR]

Aim: Exploring how negative symptoms are experienced and understood by individuals with lived experience of psychosis has the potential to offer insights into the complex psychosocial processes underlying negative symptom presentations. The aim of the current study was to investigate lived experiences of negative symptoms through secondary analysis of interviews conducted with individuals recovering from first‐episode psychosis. Method: Transcripts of in‐depth interviews with participants (n = 24) recruited from Early Intervention in Psychosis services were analysed thematically with a focus on participants' experiences and personal understandings of features corresponding to the negative symptoms construct. Results: Descriptions of reductions in expression, motivation and sociability were common features of participants' accounts. Several participants described the experience of having difficulty interacting as like being a "zombie". Some participants experienced diminished capacity for emotion, thought or drive as underlying these experiences. However, participants typically attributed reductions in expression, motivation and sociability to medication side‐effects, lack of confidence or active avoidance intended to protect them from rejection or ridicule, sometimes linked to internalized stigma. Conclusions: Personal accounts of experiences of reduced expression, motivation and sociability during first‐episode psychosis highlight the personal meaningfulness and role of agency in these features, challenging the framing of negative symptoms as passive manifestations of diminished capacity. [ABSTRACT FROM AUTHOR]

Aim: First‐episode psychosis (FEP) can be a serious and debilitating disease, but there is limited literature on how to inform patients and carers about its diagnosis and outcome. We aimed to examine the attitudes, practices and views of clinicians working in Early Intervention Service about sharing information on diagnosis and outcome of FEP. Methods: A 26‐item questionnaire was sent electronically to clinical staff who have been involved in the discussion of FEP diagnosis in Early Intervention Services in the West Midlands, UK. Results: A total of 51 clinicians completed the questionnaire. All respondents stated that patients or carers of those presenting with FEP wish to be informed of their diagnosis, and three‐quarters (76%) felt there is a need to develop guidelines on how to inform about diagnosis; 57% stated that they usually use broad diagnostic groups such as psychosis when discussing diagnosis, and only 11% use the term schizophrenia. A total of 40% thought that the therapeutic relationship and treatment adherence (58%) would improve if patients know about their diagnosis; 42 (88%) respondents felt that the likely outcome of the illness should also be discussed with patients when the diagnosis is communicated. Conclusion: The clinicians were aware that service users wished to be informed about the diagnosis and outcome of FEP but had no guidance on the subject. Despite the limitations of an online self‐administered survey, the study highlights the need for guidance and improving clinical practice in discussing the diagnosis of FEP in a vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Personality disorder is highly prevalent in offender populations and is associated with poor health, criminal justice, and social outcomes. Research has been conducted into factors that influence offending and health, but, in order to improve (re)habilitation, service providers must also be able to identify the variables associated with social outcomes and the mechanisms by which they operate.Aim: To establish what is known about what influences social outcomes among offenders with personality disorder.Method: A systematic review was completed using Cochrane methods, expanded to include nonrandomised trials. Anticipated high heterogeneity informed a narrative synthesis.Results: Three studies met inclusion criteria. Two were qualitative studies including only 13 cases between them. All studies were low quality.Conclusions: There is insufficient evidence to determine what influences good social outcomes among offenders with personality disorder. Research is required to identify associated variables, to inform the development of effective interventions. [ABSTRACT FROM AUTHOR]

Aim: Early intervention services (EIS) for psychosis are being implemented, internationally. It is important to learn from established examples and define the components and intensity of services that provide good value for money. This study aims to assess the cost‐effectiveness of EIS according to how closely they adhered to the recommendations of the English Department of Health 2001 Policy Implementation Guide (PIG). Methods: EIS from the National Eden Study were assessed using a measure of fidelity to the PIG that rated the presence or absence of 64 recommended items relating to team structure and practice. EIS were then classified into three groups: those with fidelity of 75–80%, 81–90% and 91–95%. Patient‐level resource use and outcomes were measured 1 year following inception into the service; costs were calculated and combined with quality‐adjusted life years (QALYs) gained. Results: At a threshold of £20 000 per QALY, the 81–90% fidelity group had a 56.3% likelihood of being the most cost‐effective option followed by 75–80% fidelity at 35.8% and 91–95% fidelity group (7.9%). Conclusions: The results from England suggest that striving to maximize fidelity may not be warranted, but that dropping below a certain level of fidelity may result in inefficient use of resources. [ABSTRACT FROM AUTHOR]

• 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. [ABSTRACT FROM AUTHOR]

Background Children in the UK care system often face multiple disadvantages in terms of health, education and future employment. This is especially true of mental health where they present with greater mental health needs than other children. Although transition from care - the process of leaving the local authority as a child-in-care to independence - is a key juncture for young people, it is often experienced negatively with inconsistency in care and exacerbation of existing mental illness. Those receiving support from child and adolescent mental health services ( CAMHS), often experience an additional, concurrent transfer to adult services ( AMHS), which are guided by different service models which can create a care gap between services. Method This qualitative study explored care-leavers' experiences of mental illness, and transition in social care and mental health services. Twelve care-leavers with mental health needs were interviewed and data analysed using framework analysis. Results Sixteen individual themes were grouped into four superordinate themes: overarching attitudes towards the care journey, experience of social care, experience of mental health services and recommendations. Conclusions Existing social care and mental health teams can improve the care of care-leavers navigating multiple personal, practical and service transitions. Recommendations include effective Pathway Planning, multiagency coordination, and stating who is responsible for mental health care and its coordination. Participants asked that youth mental health services span the social care transition; and provide continuity of mental health provision when care-leavers are at risk of feeling abandoned and isolated, suffering deteriorating mental health and struggling to establish new relationships with professionals. Young people say that the key to successful transition and achieving independence is maintaining trust and support from services. [ABSTRACT FROM AUTHOR]

Background: The UK guidelines on the treatment of personality disorder recommend avoiding compulsory treatment except in extreme situations. Little is known about how often patients with personality disorder are detained or how this compares with the treatment of other mental disorders. Objectives: Our aim is to test the hypothesis that people with personality disorder are infrequently detained under the Mental Health Act (MHA) and that risk factors associated with detention are the same as those for people with other mental disorders. Method: We used a retrospective, quantitative study of MHA assessments. Results: Of the 2 087 assessments undertaken, 204 (9.8%) patients had a diagnosis of personality disorder; 40.7% of assessments in the personality disorder group resulted in detention, as did 69.7% of patients with other mental disorders. A higher proportion of people with personality disorder received no intervention following assessment compared with those with other mental disorders (20.6% vs. 4.7%, p < 0.001). Study centre and a history of admission were risk factors for detention in both groups. Risk was a predictor of detention in those with other mental disorders. Conclusions: Detention rates in patients with personality disorder are lower than those for other disorders but are still substantial. Risk factors for detention in patients with personality disorder differ from those with other mental disorders. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Recently, school mobility was identified as a risk factor for psychotic symptoms in early adolescence. The extent to which this risk continues into late adolescence and the trajectories via which this risk manifests remain unexplored. Methods: Psychotic symptoms in 4,720 adolescents aged 18 were ascertained by trained psychologists using the Psychosis-Like Symptoms Interview. Mothers reported on sociodemographic factors (i.e., family adversity, ethnicity and urbanicity) from pregnancy to 4 years; child's involvement in bullying at age 6-7 years; residential mobility at 11 years and school mobility at 11-12 years. Young people reported on their friendships at 8 years, and antisocial behaviour and cannabis use at 15 years. Results: School mobility across childhood significantly predicted psychotic symptoms at 18 years (adjusted odds ratio = 2.15; 95% confidence intervals = 1.06, 4.40). Within path analysis, school mobility (β = .183, p = .035), involvement in bullying (β = .133, p = .013), antisocial behaviour (β = .052, p = .004), cannabis use (β = .254, p = .020) and female sex (β = .420, p < .001) significantly predicted psychotic symptoms. Residential mobility (β = .375, p < .001), involvement in bullying (β = .120, p = .022) and poor friendships (β = .038, p = .014) significantly predicted school mobility. Residential mobility indirectly increased the risk of psychotic symptoms via school mobility (β = .069, p = .041). Conclusions: Children who move schools often are more likely to have experienced peer problems. School mobility, in turn, appears to be a robust marker for psychotic symptoms in late adolescence. Clinicians and teachers should consider school mobility as an important risk indicator for both peer problems and psychopathology. [ABSTRACT FROM AUTHOR]

Aim As a foundation for considering how gains may be maintained following early intervention in first-episode psychosis ( FEP), this study aimed to describe and investigate factors predicting post-discharge relapse and longer term functioning. Method An evaluation via case-note review obtained quantitative data on 163 patients sequentially discharged from Birmingham Early Intervention Service ( EIS) followed up for a median of 3.6 years. Time to relapse was calculated and hierarchical regression was used to determine predictors of relapse and functioning. Results Patients likely to relapse do so within the first year post-discharge; however, over 40% did not relapse during the follow-up period. The number of relapses occurring during EIS care predicted time-to-relapse post-discharge. At discharge from the EIS and study end-point, the proportion with low social and vocational functioning remained high. Predictors of positive 'Not in Education Employment or Training' status at end-point include being in a minority ethnic group, substance misuse and number of relapses. Conclusions Increased emphasis on relapse prevention and early post-discharge monitoring may be needed, especially in the first year, for those who have experienced previous relapse. To maintain early outcomes in FEP, targeted interventions to address substance misuse and functional recovery need to be sustained in the long term. EISs should aim to make the first episode of psychosis the last. Services providing care for patients with psychosis post EIS should be designed to deliver care for ongoing need, with continued emphasis on relapse prevention and social recovery. [ABSTRACT FROM AUTHOR]

Aim Ensuring a seamless transition from child to adult mental health services poses challenges for services worldwide. This is an important process in the ongoing care of young people with mental illness; therefore, it is incumbent on all countries to probe their individual structures to assess the quality of mental health service delivery to this vulnerable cohort. To date, there have been no published studies on the transition from Child to Adult Mental Health Services in the Republic of Ireland. To this end, a nationwide survey of transition policies of community mental health teams in both services was conducted in order to compare best practice guidelines for transition with current process and experience in clinical practice. Method Structured interviews were conducted with 57 consultant psychiatrists (representing 32 CAMHS teams and 25 AMHS teams) to obtain information on annual transition numbers, existing transition policies and operational practice from the professional perspective. Results Numbers of young people considered suitable for transfer to adult services ( M = 7.73, SD = 9.86, n = 25) were slightly higher than numbers who actually transferred ( M = 4.50, SD = 3.33, n = 20). There is a lack of standardized practice nationwide regarding the service transition boundary, an absence of written transition policies and protocols, and minimal formal interaction between child and adult services. Conclusions The findings suggest that there are critical gaps between current operational practice and best practice guidelines. Future studies will investigate the impact this has on the transition experiences of young people, their carers and health-care professionals. [ABSTRACT FROM AUTHOR]

Aims To develop and populate a plausible model of the impact of early intervention ( EI) for children and adolescents with psychosis to estimate potential short-term health-related cost savings compared to generic Child and Adolescent Mental Health Services ( CAMHS). Method A decision-tree-based model for EI in CAMHS was developed. The model was populated using data relating to the use of inpatient care and EI service activity for people aged under 18 from an area of North East England. Data were abstracted from the National Health Service clinical reporting systems for 2001-2008. Sensitivity analyses were performed to examine costs associated with the model under differing assumptions. Results EI delivered cost savings of £4814 per patient compared to care provided by generic CAMHS. Cost savings were predominantly a consequence of reduced length of hospital admissions for patients served by the EI team. The findings were robust to sensitivity analyses. Conclusions These findings suggest that EI services for children and adolescents with psychosis provide potential direct health cost savings comparable to those observed for working-age adults. [ABSTRACT FROM AUTHOR]

Aim: We conducted a 1-year prospective evaluation of an early intervention in psychosis service (Early Treatment and Home-based Outreach Service (ETHOS)) during its first 3 years of operation in South-west London, UK. Methods: All patients referred to ETHOS underwent structured assessments at baseline and at 1-year follow-up. In addition, hospitalization rates of ETHOS patients (intervention group) were compared with a non-randomized parallel cohort (comparison group) of first-episode patients treated by community mental health teams. Results: The Early Treatment and Home-based Outreach Servicepatients experienced significant improvements in symptomatic and functional outcomes, especially vocational recovery. The service received only a quarter of eligible patients from referring teams. ETHOS patients did not differ from the comparison group in number of admissions, inpatient days or detention rates. Although number of referrals increased over time, there was no evidence that patients were being referred earlier. Conclusions: There is now robust evidence for the effectiveness of specialist early intervention services. However, such services must be adequate resourced, including an early detection team and provision of their own inpatient unit. [ABSTRACT FROM AUTHOR]

The General Medical Council's document `Tomorrow's Doctors' (1993, GMC, London) recommended major changes in the undergraduate curricula of UK medical schools. In Nottingham, the fourth‐year psychiatric attachment became shorter in duration, and interactive, problem‐oriented, workshop‐based learning replaced lectures. We compared the efficacy of this new teaching style in changing medical students' attitudes towards psychiatry and mental illness with that of old‐style, didactic, lecture‐based teaching. On the first and last days of their psychiatric attachment, 110 fourth‐year medical students (45 old curriculum; 65 new curriculum) completed two self‐administered attitudinal measures: the Attitude to Psychiatry Questionnaire (ATP‐30) and the Attitude to Mental Illness Questionnaire (AMI). We found that students had favourable attitudes towards psychiatry and mental illness before the attachment. These attitudes became more positive after the attachment in students from both curricula, with no significant difference between the groups and no gender difference. Students found patient contact rewarding, become more accepting of community care, and had greater appreciation of the therapeutic potential of psychiatric interventions. The interactive, student‐centred, problem‐oriented teaching of the shortened new curriculum appeared as effective in changing medical students' attitudes as a longer attachment with traditional teaching. [ABSTRACT FROM AUTHOR]

AimsTo compare the efficacy of two teaching styles, didactic teaching and problem based learning, in producing enduring change in final-year medical students’ attitudes towards psychiatry and mental illness. MethodA 1-year follow-up questionnaire survey of two groups of medical students taught psychiatry in their fourth-year training by two different methods. One-year follow-up scores were compared with pre-attachment and post-attachment scores in the fourth year. Results70 (68%) students completed both questionnaires at follow-up. The follow-up scores were significantly lower compared with both the fourth-year pre-attachment and post-attachment scores, suggesting that the positive change in attitudes following psychiatric training in the fourth year significantly decayed during the final year. The two teaching methods did not differ in the magnitude of this reduction. ConclusionsThe positive change that occurs in medical students’ attitude towards psychiatry, psychiatrists and mental illness after their fourth-year psychiatric training is transient and decays over the final year. [ABSTRACT FROM AUTHOR]

The author reflects on the aspects of disclosing the diagnosis and outcome of schizophrenia to the patients. Topics discussed include the issues related to the cross cultural challenges related to the diagnosis and treatment of schizophrenia, the controversies and uncertainties on the terminologies associated to the term schizophrenia, and the aspects of what, how, and when to share the information on the outcome and diagnosis of the disease.

A letter to the editor is presented about the outcome of an early intervention in psychosis service in Great Britain.