Leads: Dr Helena Tuomainen, Dr Domenico Giacco, Prof Swaran Singh (Youth Mental Health), Dr Nick Parsons (Meths)

To develop this proposal, the team are working closely with two young project advisors who had experience of working with the team on a previous project, MILESTONE. In addition to shaping the project questions and design, the advisors are co-designing further public involvement activities to shape the proposal.

Dates: June 2020 - May 2021

Background:

Young people (aged 16-25 years) with mental health problems have poor mental health and functional outcomes. In the first UK study, Singh, et al. (2010) found that just 4% of young people transitioning from Child and Adolescent Mental Health Services (CAMHS) received an ideal transition, and that youth with neurodevelopmental disorders, and emotional disorders were especially likely to fall through the gap in service provision. A recent systematic review of thirteen studies (Appleton, et al., 2019) found that just one quarter of young people who reached the CAMHS boundary directly transitioned to Adult Mental Health Services (AMHS). The remainder experienced varied outcomes and multiple transitions. Young people discharged from CAMHS to general practice can experience feeling abandoned and many individuals have poor functioning and wellbeing.

GPs often do not have the skills or resources to provide sufficient care to young people discharged from CAMHS. We propose the development of a collaborative care model (CCM), to strengthen general practice and the interface with specialist mental health services. The shape and components of the CCM will be developed and tested as part of a Programme Grant for Applied Research (PGfAR). Before we develop and implement the CCM, we need more information about the extent and shape of the problem facing GPs caring for transition-aged young people (TAYP) in England. Therefore, we intend to submit a Programme Development Grant (PDG) application to collect this information.

Policy and Practice Partners:

University of Keele, University of Exeter, University of Manchester, Coventry and Warwickshire Partnership NHS Trust and associated primary care trust, up to two further NHS mental health trusts, and associated primary care trusts (tbc), Clinical Practice Research Datalink (CPRD) (tbc).

Co-Funding Partners:

TBC - Coventry and Warwickshire Partnership NHS Trust.

Aims and Objectives:

The research project linked to this will have the following aims:

1. Enable the assessment and mapping of the extent of the problem GPs experience in managing mental health of transition-aged young people (TAYP) in England.
   1. Establish the linkage of CPRD Aurum and CAMHS Dataset.
2. Identify elements of a sound model of primary care based collaborative care for transition-aged young people with continued mental health needs.
   1. Assess elements of CCM suitable for supporting young people with mental health problems.
   2. Analyse and develop the theoretical basis for collaborative care for TAYP.
3. Identify problems and solutions at the GP and secondary mental health care interface for supporting mental health of TAYP in general practice as part of a CCM.
   1. Explore barriers and facilitators of effective CCM at NHS mental health and primary care trusts, including key stakeholder groups.

Methods:

As part of the development of the PDG bid, we plan to:

• Bring together a team of experts, including young people with lived experience, to develop the bid.
• Write a commentary for British Journal of General Practice.
• Conduct a systematic review of young people’s (12-25) experiences, views and needs regarding mental health care in general practice.
• Conduct a scoping review of collaborative care models implemented in primary care targeting young people.
• Conduct further analysis of MILESTONE interviews with young people who did not transition to AMHS from CAMHS.
• Patient and Public Involvement and Engagement (PPIE) work: conduct exploratory discussions with young people, and GPs; apply for Research Design Service WM Public Involvement Fund to have a dialogue with young people about accessing care from GPs and further shape the application.
• Complete an application to CRPD for the linkage of CRPD and CAMHS dataset, as these datasets are not yet linked.
• Explore the possibility of conducting exploratory research at Coventry and Warwickshire Partnership Trust (CWPT).
• Conduct a scoping review of CCM aimed at young people with mental health problems.

Main Results:

To support the development of the bid for a PDG:

• A multidisciplinary team has been formed and includes a PPIE lead, two young PPIE advisors, colleagues from Manchester with experience of CPRD data, and an implementation science expert.
• Commentary in BJGP Open has been published (Appleton, et al., 2020).
• Searches and data extraction for the systematic review has been completed; only a handful of articles were found that address young people’s experiences and needs.
• PPIE work has highlighted problems faced by GPs and young people; Research Design Service WM funding has been received to support discussions about the project with young people with relevant lived experience.
• CWPT has been identified as a viable case study for the research.
• A person has been identified who could undertake the scoping review.

Conclusions:

Good progress has been made towards developing of a proposal for a NIHR Programme Development Grant (aiming for May 2021 deadline), which will help examine the extent and shape of the problems at the GP-specialist mental health service interface, and provide a good idea of what a plausible CCM should look like. If we receive the funding and do the research, the findings will contribute towards a bid for a NIHR PGfAR. The latter funding will support the development and testing of a CCM but also the analysis of quantitative data (linked CPRD and CAMHS dataset), which will support the implementation of the CCM. The ultimate aim of the CCM will be to improve the experience of general practice-based care and outcomes for transition-aged young people who no longer attend specialist mental health services.

Implications for Implementation:

A successful NIHR PDG bid will pave the way for developing and implementing a collaborative care model to help primary care and community based mental health services work closer together, thus ensuring better experience of care and outcomes for transition-aged young people with continued mental health needs. Implementation will depend on successful bid to NIHR PGfAR or another suitable funder.