Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review

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Experiences of pathways to mental health services for young people and their carers: a qualitative meta‑synthesis review Kathleen MacDonald1,2,3,4   · Manuela Ferrari1,2,3,4 · Nina Fainman‑Adelman1,2 · Srividya N. Iyer1,2,3,4 Received: 2 January 2020 / Accepted: 24 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020

Abstract Worldwide, growing concern with young people’s mental health is spurring service reform efforts. Such reform requires a full understanding of the experiences of young people and their carers when seeking mental health help. To generate such an understanding, we conducted a meta-synthesis of qualitative literature on the perspectives of youths and their carers on navigating mental health systems. Five electronic databases were searched (Medline, PsycINFO, EMBASE, CINAHL, HealthSTAR). Studies were included if they explored the experiences of pathways to mental health services of persons aged 11–30 years and/or their carers; were published in English or French; and used qualitative methodology. Quality appraisal was conducted using the CASP tool. The synthesis of 31 included studies yielded three themes—initiating contact with mental health services; characteristics of services’ response; and youths’ and carers’ appraisal of services. Themes about initiating contact included mental health literacy, structural barriers, and social support. Service response-related themes included complex pathways, waitlists, eligibility, and fragmented care. In terms of service appraisal, positive encounters featured providers who were accessible and perceived as caring. Negative appraisals resulted from feeling misunderstood and excluded and being ill-informed about treatment. Across diagnoses and settings, youths and carers had difficult experiences accessing mental healthcare. While individual, social, and healthcare factors shaping pathways to care varied, systemic complexities were a common inhibitor. This synthesis informs recommendations for improving mental health services and youths’ pathways to them. It underlines the need for grounding reform in youths’ and carers’ perspectives and needs. Keywords  Pathways to care · Meta-synthesis · Youth mental health · Qualitative · Lived experiences

Introduction

Electronic supplementary material  The online version of this article (https​://doi.org/10.1007/s0012​7-020-01976​-9) contains supplementary material, which is available to authorized users. * Kathleen MacDonald [email protected] Srividya N. Iyer [email protected] 1



Department of Psychiatry, McGill University, Montreal, Canada

2



Douglas Research Centre, Montreal, Canada

3

ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada

4

Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada



Most mental health problems have their peak incidence in adolescence and young adulthood [1]. Delayed treatment of these problems can lead to poorer treatment outcomes, including lower remiss

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