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Refugee young people have high rates of unmet mental health needs. Established barriers to accessing mental health care may be contextual to the host country and its support systems. The aim of this study was to establish the perspectives of refugee young people, parents, and service providers on service responses across one middle-income and one high-income country, Turkey and the UK, respectively. In Turkey, eight professionals (social work, psychology, and education), ten parents and ten young people took part. In the UK, stakeholders included four professionals (health, educational psychology, and non-statutory), seven parents and seven young people. Data were analyzed using a codebook thematic approach. Despite structural differences between the two systems, several commonalities were identified in responses. Conceptualization of mental health, stigma, shame, and parents' language acquisition acted as barriers to help-seeking in both countries, whilst schools were viewed as central to the initiation of interventions. Contextual barriers in Turkey included child marriage and labor, whilst reliance on non-governmental organizations (NGOs) facilitated joint care pathways. In the UK, providers aimed to adapt and extend care pathways through primary health care. Recommendations included designated policy, joint working, schools acting as service hubs, awareness, and training professionals on contextual knowledge. [ABSTRACT FROM AUTHOR]

• Child mental health interventions in Majority World Countries should be contextualized to local sociocultural needs. • Integration to existing psychosocial support can enhance uptake and maximize limited resources. • A Train-of-Trainer cascade approach has potential to widen reach and sustain impact. • Communities should be involved in the whole design and implementation process. This study evaluated the process of integrating child and youth mental health to existing psychosocial support in disadvantaged South African communities. Four child practitioners of the host organization attended a Train-of-Trainer programme. They subsequently co-produced an intervention informed by a service transformation framework along five service domains. Implementation involved 368 community participants. A sub-sample of 43 participants were engaged in focus groups on their experiences. Data were analysed through thematic analysis. Established themes were inter-linked and transcended the five intervention domains. Engagement and conceptualization of mental health through awareness were viewed as pre-requisites to application of new knowledge. This should be supported by systemic changes, predominantly community mobilization and integrated care. Knowledge transfer involving collaboration between services and communities would enable sustainability of impact. The findings led to the formulation of a Theory of Change. Integration of child and youth mental health through a cascade approach that actively involves communities in co-production and delivery can enhance service provision in resource-constrained Majority World contexts. [ABSTRACT FROM AUTHOR]

• Youth mental health support in Global South Countries should be concurrently addressed at the inter-linked relational, systems and structural levels. • Forming meaningful connections are central to accessing such support. • Youth with mental health lived experience should be incorporated in the planning, implementation and evaluation of services. Youth mental health support and services vary across sociocultural contexts. It is important to capture the perspectives of youth with lived experiences for planning needs-led interventions and services, especially in Global South Countries (GSC), with limited specialist resources and representative literature. The aim was to establish how youth with lived experiences of anxiety and depression viewed external support in different countries, and how these views were juxtaposed with those of professionals. We involved 121 youth aged 14–24 years and 62 professionals from different disciplines in eight countries, predominantly from the Global South. Two youth and one professional focus group was facilitated in each country. The data were analysed through a codebook thematic approach. Youth across all countries largely valued informal support from family, peers and community, whilst those from GSC had limited access to structural support. They related lived experiences to therapeutic engagement and processes, in contrast with professionals who focused on outcomes and service delivery. Mental health awareness and integration of interventions with social support were considered essential by both youth and professionals, especially in disadvantaged communities. The mental health needs of youth in disadvantaged GSC communities can be best met through multi-modal interventions addressing these needs across their socioecology and positioned within a stepped care model. Youth with lived experiences should be involved in service planning, implementation and monitoring. [ABSTRACT FROM AUTHOR]

Looked after children are at high risk of developing mental health problems and these are often complex and related to other needs and agency involvement. Consequently, there is increasing policy emphasis on the importance of joint service planning and implementation. In practice, however, the distinction between mental health needs, problems and disorders is not clearly defined. Therefore, there is considerable service variation, lack of models and consensus on which children and young people would benefit from specialist child and adolescent mental health services (CAMHS) input. Pradeep Rao, Alvina Ali and Panos Vostanis report on a study that aimed to compare the characteristics of looked after and adopted children referred to a designated CAMHS team, and to identify whether these fell within the perceived remit of specialist CAMHS. The referrals, over one year, were rated by an independent researcher using a checklist that contained details of the referrer, the child's placement and reason for referral, outcome and reasons for decisions. Children with indication of likely disorders were accepted, while there was less consistency on decisions related to attachment and behavioural problems, and the role of different agencies. Mental health and social care services for vulnerable children need jointly to develop clear care pathways, with definition of agency roles. The presence of behavioural and attachment problems per se should not justify referral to specialist CAMHS, which would depend on other concurrent mental health difficulties and risk factors involved. Implications for defining the role and components of mental health services for vulnerable children and young people are discussed. [ABSTRACT FROM AUTHOR]

Homelessness is recognised to be a traumatic event in itself and is often preceded by the experience of violence. More recent research has indicated that homelessness can function to enact growth and resilience in women with dependent children. This review paper draws together findings from a series of studies involving women with dependent children who experience homelessness. It identifies key psychosocial and health priorities in this population and how findings related to resilience and growth can be harnessed in therapeutic work. Pragmatic service developments and examples of good practice in therapeutic and multi-agency interventions from the domestic violence and homelessness literature are described and recommendations are made for developing services and working therapeutically with marginalised and transient populations. Therapists need to work in a flexible and integrated way with other key services, so that the crisis and long term needs of this population are met. [ABSTRACT FROM AUTHOR]

Panos Vostanis, Guv Bassi, Howard Meltzer, Tamsin Ford and Robert Goodman examine data from the England survey on the use of services by looked after children with behavioural problems (or conduct disorders -- CD). Of the total 1,039 looked after children who participated, 384 (37%) fulfilled criteria for CD, of whom 57 (or 17% of children with CD) had an additional hyperkinetic and 46 (or 12% of the CD group) an additional emotional disorder. Children had high rates of multiple and overlapping contacts with social care, health, education and youth justice services. Children with additional emotional and hyperkinetic disorders had particularly high rates of contact with primary care, specialist child and adolescent mental health services (CAMHS), child health and special educational services. In conclusion, looked after children and young people with behavioural problems are likely to require access to a range of services, but these should be clearly defined and co-ordinated, with local care pathways and referral criteria, in order to maximise the use of resources. Although CAMHS involvement should not automatically be requested for all behavioural problems, looked after children with underlying mental health or developmental disorders would particularly benefit from specialist CAMHS input. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore Gujarati parents' and adolescents' perceptions of child and adolescent mental health services and how these should be improved to best meet their needs. Semi-structured qualitative interviews were carried out with 15 parents and 15 young people, recruited from a community centre. Overall, the quality of the service appeared more important than its responsiveness to culture or ethnicity for both young people and their parents. These findings indicate the need for further evidence and debate on whether Black and ethnic minority families should be treated as though they are a homogenous group. [ABSTRACT FROM AUTHOR]

Little is known about the experiences of mothers who become homeless. The numbers of women with children in this situation are growing, most becoming homeless following domestic or neighbour abuse, or the breakdown of family relationships. This qualitative study aimed to describe mothers’ experiences of homelessness in relation to their mental health, support and social care needs. Twenty-eight homeless women with dependent children residing in hostels were interviewed. The experience of homelessness was stressful, but viewed as a respite for many of the participants because they had experienced violence and harassment prior to their stay in the hostels. Many described poor mental health, which they related to the conditions in hostels and traumas that they had experienced before becoming homeless. Their experiences and perceptions of the services available were mixed. Some valued the support offered by staff and other residents, but the majority felt that there was a lack of resources to address their needs. Many women had difficulty coping with homelessness, and several said that support from other homeless women was an important source of help. Services need to work together to meet the multiple health, social, psychological and housing needs of these women. [ABSTRACT FROM AUTHOR]

Children living in resource-constrained environments have high levels of unmet psychosocial needs. Through participatory focus groups, we juxtaposed the views of 55 children aged 7–10 years from resource-constrained settings in South Africa and Pakistan, with those of 96 service providers, focusing on available sources of psychosocial support. Children largely relied on individual and relational resources, with limited awareness of structural supports. Service providers focused less on children's capacity, instead viewing schools and community-based resources as essential sources for psychosocial support. Children's agency and capacity should be recognized and bolstered to inform service planning, community-based interventions, and systemic change. [ABSTRACT FROM AUTHOR]