Open Access Research article

Primary care and youth mental health in Ireland: qualitative study in deprived urban areas

Dorothy Leahy1*, Elisabeth Schaffalitzky1, Claire Armstrong1, Gerard Bury2, Paula Cussen-Murphy3, Rachel Davis4, Barbara Dooley5, Blanaid Gavin6, Rory Keane7, Eamon Keenan8, Linda Latham9, David Meagher1, Pat McGorry10, Fiona McNicholas6, Ray O’Connor13, Ellen O’Dea11, Veronica O’Keane12, Tom P O’Toole13, Edel Reilly14, Patrick Ryan15, Lena Sanci16, Bobby P Smyth17 and Walter Cullen1

Author Affiliations

1 Graduate Entry Medical School, University of Limerick, Limerick, Ireland

2 UCD School of Medicine & Medical Science, University College Dublin, Belfield, Dublin 4, Ireland

3 HSE Mid-West, Limerick, Ireland

4 Child & Adolescent Mental Health Services, HSE Mid-West, Limerick, Ireland

5 School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland

6 Department of Child & Adolescent Psychiatry, Lucena Clinic, Rathgar, Dublin 6, Ireland

7 Sláinte Drug & Alcohol Services, HSE Mid-West, Limerick, Ireland

8 Addiction Services, HSE Dublin Mid-Leinster, Dublin, Ireland

9 Thomas Court Primary Care Centre, Dublin 8, Ireland

10 Orygen Youth Health Research Centre, University of Melbourne, Melbourne, Australia

11 HSE Dublin Mid-Leinster, Dublin, Ireland

12 Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland

13 Providence VA Medical Centre & Warren Alpert Medical School, Brown University, Rhode Island, USA

14 Fatima Regeneration Board, Rialto, Dublin 8, Ireland

15 Department of Psychology, University of Limerick, Limerick, Ireland

16 Department of General Practice, University of Melbourne, Melbourne, Australia

17 Department of Public Health & Primary Care, Trinity College Dublin, Ireland

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BMC Family Practice 2013, 14:194  doi:10.1186/1471-2296-14-194

Published: 17 December 2013

Abstract

Background

Mental disorders account for six of the 20 leading causes of disability worldwide with a very high prevalence of psychiatric morbidity in youth aged 15–24 years. However, healthcare professionals are faced with many challenges in the identification and treatment of mental and substance use disorders in young people (e.g. young people’s unwillingness to seek help from healthcare professionals, lack of training, limited resources etc.) The challenge of youth mental health for primary care is especially evident in urban deprived areas, where rates of and risk factors for mental health problems are especially common. There is an emerging consensus that primary care is well placed to address mental and substance use disorders in young people especially in deprived urban areas. This study aims to describe healthcare professionals’ experience and attitudes towards screening and early intervention for mental and substance use disorders among young people (16–25 years) in primary care in deprived urban settings in Ireland.

Methods

The chosen method for this qualitative study was inductive thematic analysis which involved semi-structured interviews with 37 healthcare professionals from primary care, secondary care and community agencies at two deprived urban centres.

Results

We identified three themes in respect of interventions to increase screening and treatment: (1) Identification is optimised by a range of strategies, including raising awareness, training, more systematic and formalised assessment, and youth-friendly practices (e.g. communication skills, ensuring confidentiality); (2) Treatment is enhanced by closer inter-agency collaboration and training for all healthcare professionals working in primary care; (3) Ongoing engagement is enhanced by motivational work with young people, setting achievable treatment goals, supporting transition between child and adult mental health services and recognising primary care’s longitudinal nature as a key asset in promoting treatment engagement.

Conclusions

Especially in deprived areas, primary care is central to early intervention for youth mental health. Identification, treatment and continuing engagement are likely to be enhanced by a range of strategies with young people, healthcare professionals and systems. Further research on youth mental health and primary care, including qualitative accounts of young people’s experience and developing complex interventions that promote early intervention are priorities. (350 words)

Keywords:
Young people; Urban deprivation; Mental health; Substance use; Primary care; General practice