Papers by Helena Tuomainen
BackgroundLoneliness is detrimental to mental health, with university students at higher risk tha... more BackgroundLoneliness is detrimental to mental health, with university students at higher risk than other population groups. However, little research has explored interventions to reduce loneliness among students. This systematic review identifies the characteristics and effectiveness of interventions targeting students at university or college. MethodsPsycINFO, PubMed, ASSIA and Web of Knowledge were searched from inception using keywords linked to ‘loneliness’, ‘intervention’ and ‘students’. Relevant peer and non-peer reviewed English-language articles on studies implementing an intervention with loneliness as an outcome and investigating undergraduate or postgraduate students at a higher education institute were included for quality analysis and narrative review. Risk of bias was assessed at both study level and at outcome level using the revised Cochrane risk of bias tool for randomized trials (ROB2) and the risk of bias in non-randomized studies of interventions (ROBINS-I).Resul...
Social Psychiatry and Psychiatric Epidemiology
Purpose The service configuration with distinct child and adolescent mental health services (CAMH... more Purpose The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians’ advice to continue treatment at AMHS. Methods Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians’ transition recommendations. Results Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psych...
Frontiers in Psychiatry, 2022
BackgroundIn mental health, transition refers to the pathway of young people from child and adole... more BackgroundIn mental health, transition refers to the pathway of young people from child and adolescent to adult services. Training of mental health psychiatrists on transition-related topics offers the opportunity to improve clinical practice and experiences of young people reaching the upper age limit of child and adolescent care.MethodsNational psychiatrist's organizations or experts from 21 European countries were surveyed 1/ to describe the status of transition in adult psychiatry (AP) and child and adolescent psychiatry (CAP) postgraduate training in Europe; 2/ to explore the amount of cross-training between both specialties. This survey was a part of the MILESTONE project aiming to study and improve the transition process of young people at the service boundary.ResultsTransition was a mandatory topic in the AP curriculum of 1/19 countries (5%) and in the CAP curriculum of 4/17 countries (24%). Most topics relevant for transition planning were addressed during AP training i...
Data Extraction/Assessment Form (from Hawker et al., [28]). A data extraction form for a Mixed St... more Data Extraction/Assessment Form (from Hawker et al., [28]). A data extraction form for a Mixed Studies Review methodology. (DOCX 14Â kb)
Table S5. Child and adolescent psychiatry training in Europe - Available data detailed for each c... more Table S5. Child and adolescent psychiatry training in Europe - Available data detailed for each country (1). (XLS 41 kb)
Table S4. General and adult psychiatry training in Europe - Available data detailed for each coun... more Table S4. General and adult psychiatry training in Europe - Available data detailed for each country (2). (XLS 40 kb)
Table S3. General and adult psychiatry training in Europe - Available data detailed for each coun... more Table S3. General and adult psychiatry training in Europe - Available data detailed for each country (1). (XLS 39 kb)
Appendix 1 Glossary, according to UEMS, 2003. Table S1. Data extraction form elaborated for adult... more Appendix 1 Glossary, according to UEMS, 2003. Table S1. Data extraction form elaborated for adult psychiatry training. Table S2. Data extraction form elaborated for child and adolescent psychiatry training. (DOC 100 kb)
British Journal of General Practice, 2021
Background: There is an increasing demand for mental health support in primary care, especially f... more Background: There is an increasing demand for mental health support in primary care, especially for young people. To improve mental health support for young people in general practice (GP), the needs of young people must be considered. Aim: To explore the experiences of young people (aged 12-25) on receiving mental health care in general practice and identify the needs of young people who present for mental health concerns. Design and Setting: A systematic review and narrative synthesis. Method: Six databases were searched for literature relating to young people’s experiences of receiving mental health care in general practice. Additional handsearching and manual internet searching were conducted. Narrative synthesis was employed. Results: Five studies and a further two reports from manual internet searching were included for synthesis. The synthesis generated four themes: the centrality of a trusting relationship; showing empathy and taking concerns seriously; providing time to tal...
Mental Health and Illness Worldwide, 2020
In countries with distinct child and adolescent mental health services (CAMHS), access to continu... more In countries with distinct child and adolescent mental health services (CAMHS), access to continued care in adult services can be problematic for those who reach the CAMHS service boundary. This transition boundary occurs at a time of significant change for young people, both in terms of biological and social
Book synopsis: Alternative ways of thinking, analysing and performing economic geographies have b... more Book synopsis: Alternative ways of thinking, analysing and performing economic geographies have become increasingly significant in recent years, partly due to the recent financial crisis, which has had social and political consequences throughout the world. Yet there is a danger that the debate about alternatives may become simply a way of fixing global capitalism in its present crisis-ridden form. Instead, the analysis of alternative economic spaces must continue to offer a critique of the very notion of capitalism as a universal, if variable, set of social relations. This important book brings together critical analyses of alterity from across the social sciences and humanities, refining and advancing what alternative economies and polities are, how they are formed, what difficulties and problems they face, and how they might be sustained. A central theme is the need to examine critically both the material contexts and the conceptual categories deployed in the making of alternativ...
Psychological Medicine, 2021
Background Poor transition planning contributes to discontinuity of care at the child–adult menta... more Background Poor transition planning contributes to discontinuity of care at the child–adult mental health service boundary (SB), adversely affecting mental health outcomes in young people (YP). The aim of the study was to determine whether managed transition (MT) improves mental health outcomes of YP reaching the child/adolescent mental health service (CAMHS) boundary compared with usual care (UC). Methods A two-arm cluster-randomised trial (ISRCTN83240263 and NCT03013595) with clusters allocated 1:2 between MT and UC. Recruitment took place in 40 CAMHS (eight European countries) between October 2015 and December 2016. Eligible participants were CAMHS service users who were receiving treatment or had a diagnosed mental disorder, had an IQ ⩾ 70 and were within 1 year of reaching the SB. MT was a multi-component intervention that included CAMHS training, systematic identification of YP approaching SB, a structured assessment (Transition Readiness and Appropriateness Measure) and shari...
BJGP Open, 2020
Setting the scene Mental illness represents the highest proportion of disease burden for children... more Setting the scene Mental illness represents the highest proportion of disease burden for children and young people in the UK. 1 However, despite this, young people can struggle to access timely and appropriate mental health care. One particular barrier to continuity of care occurs when young people reach the upper age limit (usually 18 years) of child and adolescent mental health services (CAMHS). If they require ongoing specialist support, their care should be transferred to an adult mental health service (AMHS), through a purposeful and planned transfer of care known as 'transition'. However, only around a quarter of young people transition to AMHS, 2 and in the absence of specialist adult mental health care, GPs often become involved in the young person's care 'by default'. 3 Although GPs become responsible for the young person's care after they leave CAMHS, they may not have the necessary skills and resources to manage complex mental health difficulties in young people.
Journal of Children's Services, 2020
Purpose Young people transitioning from child to adult mental health services are frequently also... more Purpose Young people transitioning from child to adult mental health services are frequently also known to social services, but the role of such services in this study and their interplay with mental healthcare system lacks evidence in the European panorama. This study aims to gather information on the characteristics and the involvement of social services supporting young people approaching transition. Design/methodology/approach A survey of 16 European Union countries was conducted. Country respondents, representing social services’ point of view, completed an ad hoc questionnaire. Information sought included details on social service availability and the characteristics of their interplay with mental health services. Findings Service availability ranges from a low of 3/100,000 social workers working with young people of transition age in Spain to a high 500/100,000 social workers in Poland, with heterogeneous involvement in youth health care. Community-based residential facilitie...
European Child & Adolescent Psychiatry, 2020
The paediatric-adult split in mental health care necessitates young people to make a transition b... more The paediatric-adult split in mental health care necessitates young people to make a transition between services when they reach the upper end of child and adolescent mental health services (CAMHS). However, we know that this transition is often poor, and not all young people who require ongoing support are able to continue care in adult mental health services (AMHS). These young people are said to have fallen through the gap between services. This research aimed to explore the reasons why young people fall through the gap between CAMHS and AMHS, and what effect this has had on them and their families. Narrative interviews were conducted with 15 young people and 15 parents, representing 19 unique transition stories. Themes were identified collaboratively using thematic analysis. Reasons for falling through the gap were grouped into systemic problems and problems with the quality of care received. Effects of falling through the gap were grouped into separate themes for young people (...
BMJ Open, 2020
ObjectiveYoung people moving from child and adolescent mental health services (CAMHS) to adult me... more ObjectiveYoung people moving from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) are faced with significant challenges. To improve this state of affairs, there needs to be a recognition of the problem and initiatives and an urgent requirement for appropriate tools for measuring readiness and outcomes at the transfer boundary (16–18 years of age in Europe). The objective of this study was to develop and validate the Transition Readiness and Appropriateness Measure (TRAM) for assessing a young person’s readiness for transition, and their outcomes at the transfer boundary.DesignMILESTONE prospective study.SettingEight European Union (EU) countries participating in the EU-funded MILESTONE study.ParticipantsThe first phase (MILESTONE validation study) involved 100 adolescents (pre-transition), young adults (post-transition), parents/carers and both CAMHS and AMHS clinicians. The second phase (MILESTONE cohort study and nested cluster randomised...
BMC Pediatrics, 2020
Background Mental health disorders in the child and adolescent population are a pressing public h... more Background Mental health disorders in the child and adolescent population are a pressing public health concern. Despite the high prevalence of psychopathology in this vulnerable population, the transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) has many obstacles such as deficiencies in planning, organisational readiness and policy gaps. All these factors contribute to an inadequate and suboptimal transition process. A suite of measures is required that would allow young people to be assessed in a structured and standardised way to determine the on-going need for care and to improve communication across clinicians at CAMHS and AMHS. This will have the potential to reduce the overall health economic burden and could also improve the quality of life for patients travelling across the transition boundary. The MILESTONE (Managing the Link and Strengthening Transition from Child to Adult Mental Health Care) project aims to address t...
BMJ Open, 2020
IntroductionLow-income and middle-income settings like India have large treatment gaps in mental ... more IntroductionLow-income and middle-income settings like India have large treatment gaps in mental healthcare. People with severe mental disorders face impediments to their clinical and functional recovery, and have large unmet needs. The infrastructure and standards of care are poor in colonial period psychiatric hospitals, with no clear pathways to discharge and successfully integrate recovered individuals into the community. Our aim is to study the impact of psychiatric hospital reform on individual patient outcomes in a psychiatric hospital in India.Methods and analysisStructured Individualised inTervention And Recovery (SITAR) is a two-arm pragmatic randomised controlled trial, focusing on patients aged 18–60 years with a hospital stay of 12–120 months and a primary diagnosis of psychosis. It tests the effectiveness of structural and process reform with and without an individually tailored recovery plan on patient outcomes of disability (primary outcome WHO Disability Assessment ...
Child and Adolescent Mental Health, 2020
Background: Transitioning from Child and Adolescent Mental Health Services (CAMHS) to Adult Menta... more Background: Transitioning from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) raises novel ethical aspects for healthcare professionals, as well as for young people, their parents and carers. Method: Focus groups were conducted in Croatia, Ireland and the United Kingdom with youth mental health groups and youth representatives with no mental health (MH) remit. One hundred and eleven participants, aged from 16 to 60 years, contributed to discussions. Results: Perpetuation of stigma, autonomy and decision-making were central themes as both enablers and deterrents of successful transition. The tension between professional (and at times parental) paternalism and young persons' growing autonomy was well captured in the themes; (a) desired practice, (b) who should decide, (c) the process of decision-making and (d) potential harm(s). Conclusions: This study provides insight into the ethical values, particularly autonomy and collaboratively working, which people expect to underpin the transition between CAMHS and AMHS. Key Practitioner Message • Engaging young people early in making decisions about their future care can enhance trust between practitioner and the young person. • In addition to diagnosis, a number of factors (such as moving home; waiting lists and stigma) may need to be taken into account when considering the direction of future health care. • When possible, alternatives to AMHS should be considered if considered by the young person to be a lessstigmatising treatment option. Keywords: Transition; child and adolescent mental health services; adult mental health services; decision-making; qualitative research; ethics † The members and partner institutions of MILESTONE Consortium group are listed in Appendix 1.
BJPsych Bulletin, 2020
The transition from child and adolescent to adult mental health services for young people with me... more The transition from child and adolescent to adult mental health services for young people with mental health problems is of international concern. Despite the high prevalence of mental disorders during adolescence and their tendency to continue during adulthood, the majority of young people do not experience continuity of care. The aim of this review paper is to unravel the complexity of transitional mental healthcare to clinicians, policy makers and mental health service managers, and to address challenges to a smooth transition process at all levels.
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Papers by Helena Tuomainen