Hoe geestelijke gezondheidszorg-aanbod voor de transitieleeftijd vormgeven: vergelijking van de meningen van jongeren en professionals

In adolescence and young adulthood, the brain undergoes a 'rewiring' process, making it more susceptible to stressors such as trauma, chronic stress, drug abuse, etc., which may contribute to the development of mental disorders. This period is also marked by instability due to social transitions, such as leaving home, completing education, and gaining increased freedom. Hence, it is not surprising that mental disorders typically begin early and peak by mid to late adolescence. Despite the high incidence of mental health problems and the associated need for care in young people, evidence points to low accessibility of services, with young people having the worst access to mental health care compared to other age groups. Therefore, the main aims of the work presented in this doctoral thesis were to investigate 1) young people's attitudes towards and preferences for mental health care and 2) (dis)agreement between young people and professionals on how to provide care to young people with mental health problems. Chapter 1 provides a general introduction, elaborating on the particularities of the late teens and early twenties, with a specific focus on the epidemiology of mental disorders and the dynamic nature of psychopathology. We mention potential barriers, both psychological and practical/systemic, that impede young people to access and/or continue care. The use of the term 'transition-age youth' is explained. In the second part, we provide information on the concept of youth-friendliness as an innovative strategy to improve accessibility and continuity of care. Subsequently, several gaps in the literature are identified, which we addressed in three research objectives: 1) assessing young people's and professionals' views on the short- and long-term helpfulness of coping strategies and help-seeking behaviors, 2) eliciting young people's and professionals' preferences and priorities for mental health service attributes and 3) evaluating consensus on the relevance of youth-friendly service characteristics among young people, parents, and professionals. Chapter 2 (= Objective 1) describes the results of a vignette study in 919 young people and 569 professionals in youth work, social welfare services, and mental health services. Young people generally showed positive attitudes towards the helpfulness of professional resources, in the short and in the long term. Yet, for the short term, they slightly preferred some personal coping strategies and informal sources of help over professional resources. Professionals' views were mostly consistent with those of young people. Perhaps somewhat counterintuitive, young people had more positive expectations about the impact of professional help than professionals did. Chapter 3 (= Objective 2) presents the results of a discrete choice experiment in which 258 young people participated. Young people's preferences were mainly driven by the attribute 'format', with a preference for individual over group treatment. Other attributes, in order of importance, were 'wait times' (short), 'cost' (low), 'healthcare professionals' expertise' (with youth aged 12 to 25 years), and 'location' (house in the city). However, for about half of the choice sets young people indicated they would not consult the service that most accommodated their preferences. This finding might be explained by the presence of attitudinal barriers, as we found a significant interaction between the no-choice parameter and the number of reported attitudinal barriers. The attributes 'peer support', 'opening hours', and 'anonymity' were not deemed relevant by young people. Chapter 4 (= Objective 2) covers the same discrete choice experiment in a sample of 176 professionals. Professionals found the attributes 'cost' and 'wait times' most relevant to young people's mental health service needs, indicating a preference for services characterized by affordability and minimal wait periods. In contrast with young people, they adhered less importance to the attribute 'format'. Furthermore, professionals considered a café or youth center to be the most suitable location for a service, rather than a house in the city, and they disfavored care provision by professionals in adult mental health services more than young people. The attributes 'peer support', flexible 'opening hours', and 'anonymity' were deemed relevant by professionals. Chapter 5 (= Objective 3) reports the results of a mixed-method Delphi approach on youth-friendliness involving a public panel (young people and parents) and a professional panel. For a large proportion (65%) of the items included in the Delphi questionnaire, consensus on importance was reached within both panels. However, the participants were less convinced of the feasibility of the implementation of these items. Our thematic analysis resulted in the identification of six themes: 'mental health literacy and stigma reduction', 'right person, right place, right time', 'easy and friendly access', 'developmental appropriateness', 'hearing young people's voices', and 'no man is an island'. Finally, Chapter 6 contextualizes our findings within the broader literature, with the particular goal of providing recommendations for research and clinical practice. We mention the strengths and limitations of this work. We conclude that further involvement of young people (with lived experience), in research as well as service design and delivery, is necessary to ensure that care provision for youth is youth-friendly, hopefully positively impacting future service use and engagement.