Executive Summary
There is a surge in the number of young people experiencing mental health challenges in the UK. This calls for evidence-based interventions with urgency, as statistics indicate that the rise in mental health disorders among this group is significantly high. The COVID-19 pandemic compounded such a surge amidst the inability of the existing interventions to solve the issue with the urgency required, resulting in the majority of young people self-harming or attempting suicide. This report critically reviews previous interventions and pinpoints the inadequacies and barriers that hinder their efficacy. The report proposes evidence-based intervention focused on digital mental health initiatives (DMHIs) as a potential alternative that offers accessible, cost-effective, and stigma-free support. The essay also discusses the strengths, barriers, and mitigation strategies associated with DMHIs. Thus, the report seeks to guide the development of effective and timely interventions that are evidence-based and address the mental health needs of youths and adolescents.
Introduction
Mental health among young people has been an issue of concern in the UK, warranting urgent attention by pursuing evidence-based interventions to reverse the trend. Existing literature supports this analogy, with Vizard et al. (2020) and Holding et al. (2022) revealing a concerning rise in mental health disorders with the COVID-19 outbreak compounding the issue due to lockdowns, social distancing, and service closures that exposed young people to loneliness. This crisis is of particular concern as it affects individuals during their most vulnerable developmental stage, with potentially long-lasting consequences on various life outcomes. This paper highlights the intensity of the issue and how the existing interventions have fallen short of serving the target population effectively, contributing to the problem. The paper proposes DMHIs as a plausible evidence-based approach that would come in handy to overcome the many challenges associated with conventional approaches serving the tech-savvy young population while achieving the triple aim of healthcare: individualized care, population impact, and cost-effectiveness.
Discussion of the crisis
Mental health among young people in the United Kingdom is an issue of growing concern. According to Vizard et al. (2020), as of 2020, 1 in every six 5–16-year-olds in the UK had a possible mental health illness, marking a rise from one in eight 5–19-year-olds three years away (Vizard et al., 2020). As for those with mental health challenges, a quarter of 11–16-year-olds and approximately half of 17–19-year-olds were reported to have inflicted harm on themselves or attempted suicide (Vizard et al., 2020). These numbers rose even further during the COVID-19 outbreak, disproportionately affecting young people in socioeconomically disadvantaged regions (Holding et al., 2022, P.e6366). Aspects such as lockdowns and government requirements for social distancing, digital schooling, mandated isolation, and service closures contributed to reduced access to formal and informal support, detrimentally affecting young people’s mental health (Owens et al., 2022 p.1132; Signh et al., 2020, p.113429). The immediate impact of these alarming figures extends beyond individual suffering, affecting families and communities and imposing strains on the healthcare system.
The mental health crisis attracts particular attention in this paper because it affects individuals during their most vulnerable stage of lifecycle development. Fledderjohann et al. (2021, p. 106033) argue that most of the mental health difficulties apart from those associated with old age happen before the age of 24 years and have the potential to harbor long-lasting adverse consequences throughout the life course across different outcomes encompassing school achievement, employment prospects and risk of drug abuse and violence. The vulnerability and the deliberating effect of mental health among this group notwithstanding, different regions in the UK face persistent gaps in solving the mental health needs of the young population, mainly due to service inadequacies.
The above analysis underscores the gravity of mental health among young persons as a health issue, pinpointing the need for guiding the development of effective and timely interventions. Thus far, introducing evidence-based practice is critical and imperative for solving the unmet mental health needs of young persons and preventing a generational crisis.
Intervention
Evidence-Based Practice and its Importance
Patient healthcare should be evidence-based and person-centered. Evidence-based practice (EBP) entails using clinical expertise and the most current and best available research evidence coupled with patients’ unique values, needs, and circumstances to provide holistic and individualized care, ultimately achieving optimal care and improved patient outcomes. With evidence-based care, the healthcare system can achieve reduced disparities in practice, optimize the value of care, enhance patient outcomes, and minimize expenses (Melnyk & Fineout-Overholt, 2023, p.1). Different sources of scientific evidence encompass external and internal. External scientific evidence entails the optimal available facts and information sourced from existing literature, such as journal articles and other scholarly articles. In contrast, internal sources entail information and data sourced from observation within the provider-patient dynamics. Advanced practice nurses (APRNs) are better positioned to leverage their clinical expertise, including their education, past expert experiences, and important skills, such as critical thinking and problem-solving, to build an EBP strategy. Patient perspectives also offer a distinct layer to EBP as the healthcare professionals leverage aspects such as patients’ personal values, priorities, expectations, and cultural behaviors and beliefs to tailor care that resonates with the client’s needs and expectations.
The application of EBP in healthcare practice is essential because health professionals such as APRNs can incorporate the EBP in care delivery approaches, cultivating diverse gains that directly impact care quality. EBP is critical because it helps APRNs remain consistently updated with up-to-date treatment protocols, improving their decision-making and the efficacy of patient recovery. EBP also offers an improved understanding of the risks of specific treatments and offers patients an active role in organizing their care. All these benefits are geared toward the core goal of improving patient outcomes. However, APRNs can only achieve such benefits if they fully adhere to EBP protocols encompassing several steps, including creating a spirit of inquiry, asking questions in a PICO(T) format, and gathering the most relevant evidence possible. Subsequent steps encompass incorporating the best evidence with scientific expertise and patient expectations while appraising and disseminating outcomes (Connor et al., 2023, p.7). All these steps are vital in guiding APRNs in ensuring the EBP process equally includes the key components, ultimately ensuring the best cadre of care is offered to different patients across times.
Synonymous with EBP implementation by other healthcare faculties, EBP in delivering mental health services has been gaining momentum over the years. This pattern has been influenced by the understanding that the EBP process is key to psychological development and relevant to patient life dynamics. Thus far, mental health has proposed different theoretical and conceptual frameworks and principles to govern the EBP implementation, encapsulating person-oriented, people-first service delivery and the active incorporation of patients in decisions concerning therapy and recovery. This process integrates professional expertise with the best existing evidence from randomized clinical trials, systematic reviews, and quasi-experimental, correlational, and pre-post designs coupled with constant clinical upskilling and education.
Previous Interventions that Were Used to Resolve Mental Health among Young People
The increasing number of mentally ill-health-challenged young people, coupled with the broader effect of the COVID-19 pandemic, has made the implantation of EBP interventions a must-have. According to UNICEF’s (2021) World Children Report, the surge in this crisis among young people requires international policy action to enhance the optimal mental health of the group. However, previous attempts to solve the issue have focused on enhancing support within the mainstream health and educational landscape (Department of Health and Social Care and Department for Education, 2018). A Green Paper by the Department of Health and Social Care and Department for Education (2018) stipulated procedures to enhance and include mental health support within UK schools and colleges through the introduction of a designated lead for mental health support coupled with new mental health support groups and a month waiting time for admission to specialist support. Consequently, NHS England (2019) suggested novel measures entailing financing community-based mental health amenities for young people.
However, the above policies have come under intense criticism from different authors. For instance, Griffin et al. (2022, p.1084) argued that they merely focused on joined-up working away from growing service capacity. Harris et al. (2019, p.790) and Edbrooke-Childs & Deighton (2020, p.2) posit that such amplified policy attention was set against the milieu of existing constraints on specialist service delivery associated with consistent budgetary cuts. The Local Government Association (2022) backs this analogy by arguing that financial allocations for child and youth mental health services have been subsidized as local Clinical Commissioning Groups are expenditure under 1% on average of their resources on young Person’s mental health while financing for community mental health services, school nurses and other community mental health support have been reduced by 700 million dollars between 2014/15–2020/21. The decreasing level of funding has restricted providers’ ability to meet the increasing demand for mental health services (NHS Digital, 2021), forcing many young people to wait for treatment for months (Creanna-Jennings & Hutchinson, 2020), where 1 in 5 waits for at least six months (NHS, 2018). Such a trend pinpoints a gap in service delivery among young people suffering from mental health.
Other barriers hindering young people from access to mental health services for the young population in the UK include complexities in the referral process, long waiting times, high support targets from government services, and the absence of accessible provisions (Crenna‐Jennings & Hutchinson, 2020; Edbrooke‐Childs & Deighton, 2020). Also, young people experience barriers such as apparent stigma and humiliation linked with accessing formal support, mistrust associated with a perceived lack of expert confidentiality, and preference for alternate and informal support systems, negatively affecting access to mental health services (Radez et al., 2020, p.185). The implication is that the existing interventions have been lacking both resourcefully and from accessibility and acceptability dimension
Proposed intervention to resolve the mental health crisis
In light of the above inadequacies linked with the existing intervention, developing an intervention that overcomes such barriers would be critical. Therefore, the proposed evidence-based intervention entails the implementation of digital mental health initiatives (DMHIs). Such intervention is motivated by the need to achieve the triple aim of healthcare, entailing individualized care with magnified population impact and at a lower cost. Research supports the use of DMHIs as effective for different mental health concerns, including stress (Linardon et al., 2019, p.326), anxiety (Paul et al., 2023, p.2), and depression et al. (Karyotaki et al., 2019). Current literature evidences the potential of DMHIs in vulnerable populations such as the youth and adolescents (Lehtimaki et al., 2021), higher education learners (Lattie et al., 2019), and even adolescents facing homelessness (Schueller et al., 2019). The mental health landscape has also received a financial boost in the past few decades, with approximately $ 637 million invested in 2019 alone (Shah & Berry, 2021, p.351). Scientific support coupled with development is key in enhancing access to high-quality care for young people experiencing mental health challenges.
Methodology in Obtaining and Quality Checking Papers
This paper used a systematic approach to gather and assess research papers and scholarly articles. Different reputable databases were used during the initial search, including PubMed and Cochrane. The search was affected through the use of keywords such as “young people’s mental health,” “interventions,” and “evidence-based practices.” The reliability and validity of selected papers were checked through the application of Critical Appraisal and Risk of Bias tools (CARS or CRAAP). Such a rigorous process was key in guaranteeing the quality and credibility of the evidence used in the subsequent critical review.
Critical Review
Strengths
The above intervention offers an opportunity to impactfully target this vulnerable population who are also tech savvy, aligning with their needs. The intervention would help the young people overcome the challenges associated with conventional interventions, which are associated with stigmatization, long wait times, and lack of optimal confidentiality. Consumers can access the platform at their convenience and without the need to travel to a health facility. Hence, DMHIs are cost-effective and accessible.
The proposed intervention offers an opportunity for moving evidence-based innovations into routine care settings, a process commonly known as implementation science (Bauer & Kirchner, 2020, p. 112376). Implementation science has been identified as a key area that can help accelerate the impact of scientific discoveries on practice, overcoming barriers associated with the translation of research into practice (Rubin, 2023, p. 1334).
Barriers to implementation
Aspects such as the features of the DMHI, such as the content and user interface, may affect its desirability. Also, functions such as integrating DMHIs into workflow patterns may induce resistance among healthcare professionals, hindering timely and optimal implementation. With many DMHIs needing to be more complex, efforts to decipher complex, multi-component behavioral therapies into online content may be challenging for users to understand (Connolly et al.,2021). Poor user experiences may also lead to negative attitudes, negating possible extensive reach (Connolly et al., 2020). Such barriers cause users to drop out of the program. Also, regular software updates may create barriers as health professionals and consumers may need to be re-trained on the new features, making it burdensome.
Mitigation
It would be critical to identify the specific challenges and implement mitigation plans. For instance, issues emanating from the DMHI platform should be exposed to software updates that remove the hurdles. It would also be critical to conduct regular training to ensure health professionals and consumers are conversant with the user interface while also factoring in the user feedback to address emerging issues and provide a seamless system.
Linkages
There is a linkage between the proposed intervention and the improvement of population health, well-being, support for vulnerable groups, and advancements in healthcare system approaches. The proposed intervention is evidence-based, ensures optimal alignment with best practices, and can address the identified crisis holistically.
Conclusion
The report identifies an existing health crisis, which is surging mental health challenges among young people in the UK, while highlighting the need for evidence-based intervention. The report highlights the gaps in existing intervention while proposing an evidence-based approach that would overcome hurdles the target population experiences in their effort to access mental health services. With the proposed intervention demonstrating potential benefits that sidestep any possible limitation, this report concludes that DMHIs are the way to go to reverse the prevailing rise in mental health challenges among young people in the UK.
Bibliography
Bauer, M.S. and Kirchner, J. (2020) ‘Implementation science: What is it and why should I care?’, Psychiatry Research, 283, p. 112376. doi: 10.1016/j.psychres.2019.04.025.
Bennett, C. et al. (2023) ‘Crisis care for children and young people with mental health problems: National mapping, models of delivery, sustainability and experience (CAMH-CRISIS2). A study protocols.’, NIHR Open Research, 3, p. 22. doi:10.3310/nihropenres.13414.2.
Crenna-Jennings, W. and Hutchinson, J. (2022) Access to child and adolescent mental health services in 2019, Digital Education Resource Archive (DERA). Available at: https://dera.ioe.ac.uk/id/eprint/34811/ (Accessed: 16 January 2024).
Connor, L. et al. (2023) ‘Evidence‐based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review’, Worldviews on Evidence-Based Nursing, 20(1), pp. 6–15. doi:10.1111/wvn.12621.
Connolly, S.L. et al. (2021) ‘Digital clinics and mobile technology implementation for mental health care,’ Current Psychiatry Reports, 23(7). doi:10.1007/s11920-021-01254-8.
Connolly, S.L. et al. (2020) ‘Leveraging implementation science to understand factors influencing sustained use of mental health apps: A narrative review,’ Journal of Technology in Behavioral Science, 6(2), pp. 184–196. doi:10.1007/s41347-020-00165-4.
Department of Health and Social Care and Department for Education (2018) Transforming children and young people’s mental health provision: a green paper, Gov.UK. Available at: https://www.gov.uk/government/consultations/transforming-children-and-young-peoples-mental-health-provision-a-green-paper (Accessed: 16 January 2024).
Edbrooke-Childs, J. and Deighton, J. (2020) ‘Problem severity and waiting times for young people accessing mental health services,’ BJPsych Open, 6(e118), pp. 1–7. doi:10.1192/bjo.2020.103.
Fledderjohann, J. et al. (2021) ‘Mental health and care needs of British children and young people aged 6–17’, Children and Youth Services Review, 126, p. 106033. doi: 10.1016/j.childyouth.2021.106033.
Harris, J. et al. (2022) ‘Using knowledge brokering to produce community-generated evidence,’ Evidence & Policy, 18(4), pp. 789–805. doi:10.1332/174426421×16190024737973.
Holding, E. et al. (2022) ‘Exploring young people’s perspectives on Mental Health Support: A qualitative study across three geographical areas in England, UK,’ Health & Social Care in the Community, 30(6), pp. e6366–e6375. doi:10.1111/hsc.14078.
Karyotaki, E. et al. (2019) ‘Guided or self-guided internet-based cognitive–Behavioral therapy (ICBT) for depression? study protocol of an individual participant data network meta-analysis’, BMJ Open, 9(6). doi:10.1136/bmjopen-2018-026820.
Lattie EG, Adkins EC, Winquist N, Stiles-Shields C, Wafford QE, Graham AK. Digital mental health interventions for depression, anxiety, and enhancement of psychological well-being among college students: systematic review. J Med Internet Res. 2019;21(7):e12869.
Linardon, J. et al. (2019) ‘The efficacy of app‐supported smartphone interventions for mental health problems: A meta‐analysis of Randomized Controlled Trials’, World Psychiatry, 18(3), pp. 325–336. doi:10.1002/wps.20673.
Local Government Association (2022) Children and Young People’s Mental Health, Local Government Association. Available at: https://www.local.gov.uk/topics/children-and-young-people/children-and-young-peoples-mental-health (Accessed: 16 January 2024).
Melnyk, B.M. and Fineout-Overholt, E. (2023) Evidence-based practice in Nursing & Healthcare: A guide to best practice. Philadelphia: Wolters Kluwer.
NHS (2019) NHS Long Term Plan,NHS.UK. Available at: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf (Accessed: 16 January 2024).
NHS Digital (2021) Mental Health of Children and Young People in England 2021 – wave 2 follow up to the 2017 survey, NHS choices. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england (Accessed: 16 January 2024).
Owens, M. et al. (2022) ‘Mental health and wellbeing in young people in the UK during lockdown (COVID-19)’, International Journal of Environmental Research and Public Health, 19(3), p. 1132. doi:10.3390/ijerph19031132.
Pauley, D. et al. (2021) ‘Two decades of digital interventions for anxiety disorders: A systematic review and meta-analysis of treatment effectiveness,’ Psychological Medicine, pp. 1–13. doi:10.1017/s0033291721001999.
Radez, J. et al. (2020) ‘Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of Quantitative and Qualitative Studies’, European Child & Adolescent Psychiatry, 30(2), pp. 183–211. doi:10.1007/s00787-019-01469-4.
Rubin, R. (2023) ‘It takes an average of 17 years for evidence to change practice—the burgeoning field of implementation science seeks to speed things up’, JAMA, 329(16), p. 1333. doi:10.1001/jama.2023.4387.
Schueller, S.M. et al. (2019) ‘A mobile phone–based intervention to improve mental health among homeless young adults: Pilot feasibility trial’, JMIR mHealth and uHealth, 7(7). doi:10.2196/12347.
Shah, R.N. and Berry, O.O. (2021) ‘The rise of Venture Capital Investing in Mental Health,’ JAMA Psychiatry, 78(4), p. 351. doi:10.1001/jamapsychiatry.2020.2847.
Singh, S. et al. (2020) ‘Impact of COVID-19 and Lockdown on Mental Health of Children and Adolescents: A Narrative Review with Recommendations’, Psychiatry Research, 293, p. 113429. doi: 10.1016/j.psychres.2020.113429.
Unicef (2021) The state of the world’s children 2021, UNICEF. Available at: https://www.unicef.org/reports/state-worlds-children-2021 (Accessed: 16 January 2024).
Vizard, T., Sadler, K. and Ford, T. (2020) Mental Health of Children and Young People in England, 2020: Wave 1 follow up to the 2017 survey, NHS choices. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2020-wave-1-follow-up (Accessed: 16 January 2024).
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