Mental health problems in young people are increasing. Suicide remains a leading cause of death in those aged 15-24 worldwide. The majority of mental health problems develop before the age of 25 but have their roots usually in childhood and teenage years. If left untreated, mental health problems can persist into adulthood with poorer prognosis and greater disability over the life course. In this blog post, Maria Michail, Jo Robinson, Tina Yutong Li, Sadhbh Byrne explore how primary care services can become more accessible and acceptable to vulnerable young people. This post has been co-produced with young people with lived experience of mental-ill health and highlights the importance of making primary care health services more accessible, acceptable and equitable for vulnerable young people.
Many of the mental health challenges young people face are preventable with timely and appropriate support. Intervening early to prevent poor mental health is key as highlighted by the recently launched Mental Health Policy Commission in the UK https://www.birmingham.ac.uk/research/impact/policy-commissions/mental-health/index.aspx. General Practitioners (GPs) play a key role in promoting good health and wellbeing. They are often the first port of call for health-related problems and are frequently the gatekeepers to specialist services.
Then why is it that so many young people, particularly young men, are reluctant to visit their GP? Young people themselves provide a number of reasons for this. Fear of their concerns being dismissed by their GP and “speaking a different language” are among the main barriers for young people seeking help from their GP for mental health problems.
Primary care is an appropriate setting for early detection and management of mental health problems in young people. As such, it is vital that primary care services are set up to be youth-friendly. Based on research conducted across the UK and Australia, we propose five simple ways in which primary care services could be more accessible to young people:
1. Meaningful youth involvement in service design
Valuing young people as equal partners in planning and designing of primary care services is vital in ensuring services are set up to meet the needs of young people. Involvement may include establishing advisory groups, co-developing youth-directed projects, regular feedback and implementation sessions. Meaningful youth engagement is crucial for all young people attending primary health services, especially, those with complex needs such as those who identify as LGBTQ, those who self-harm or those with co-current physical ill-health.
2. Clear communication
This could be a make-or-break for building a trusting healthcare relationship with young people!
“I was talking to my GP while he was staring at his computer typing away….I might as well talk to the computer...”
Allowing young people the time and space to express their feelings and responding with compassion, empathy and respect should be a key principle of a youth-friendly primary care service. GPs providing clear information about things that some young people might be particularly worried about such as confidentiality (and its limits) and privacy could improve young people’s experience of receiving care and support in primary care.
3. Co-producing a treatment plan with young people
Young people should be front and centre of decisions made about their care. This involves talking with young people about their options, providing them with clear information to make their own decisions, and listening to their concerns. Whilst some young people attending primary services may not be at legal consenting age, it is important to realise that many are still capable of achieving sound understanding of the information discussed. Primary care should be a place where young people are empowered to engage in shared decision making through collaborative working ensuring the care they receive is personalised.
4. Inclusive and accessible clinical spaces
Clinical spaces co-designed with young people are more likely to be acceptable, accessible and inclusive. This could include:
· offering free Wi-Fi to help encourage the uptake of online health services or for using to distract themselves while waiting for their appointment
· having co-located allied health professionals to provide psychological support
· ensuring non-healthcare staff such as receptionists are attuned to the needs and sensitivities of vulnerable young people and can respond with compassion
5. Using technology as an ally
Young people are digital natives. There are many examples where the use of technology has revolutionised healthcare provision. For example, telemonitoring can help lower blood pressure for people living with hypertension https://www.sciencedaily.com/releases/2018/02/180228092234.htm.
Similarly, technology could be used in primary care to facilitate engagement, communication and access particularly for young people who might be reluctant to visit their GP. For example, Doc Ready https://www.docready.org/#/home is an online resource young people can use to prepare for the first time they visit their GP to discuss their mental health. Videos on the website of GP practices could prepare young people about what to expect from their appointment. As one young person we asked said “It'd be good to know what you're expected to get when you go to your GP for mental health. Because myself, just two days ago actually, it's the first time I saw a GP for my mental health… they didn't say what a GP would do for me… I always get told go see a GP, but I don't actually know what GPs do for mental health.”
Where do we go from here?
Primary care has a key role in providing equitable, accessible and acceptable services to young people with mental health difficulties. If, as figures show, young people are less likely to visit their GP then we need to be asking why this is so and what can we do to improve that. The following quote by a young person talking about their own experience visiting their GP shows exactly how to do that “I think as well maybe just one other random point is, allowing people to have autonomy over their own experience. It's a lot more empowering to have that sort of ownership over your own experience, rather than feeling like someone's almost controlling your life.”