The role of non-clinical support services in improving functional outcomes among young adults with mental disorders in Australia: evidence to inform mental health service planning

Background: Young adulthood is a period of rapid cognitive and psychosocial change and successful progress through this period helps to establish healthy foundations for the future. Unfortunately, it is also a period when mental disorders are the most prevalent. For young adults, mental disorders can have significant impacts on day-to-day functioning while also negatively influencing future life outcomes. Non-clinical support services, sometimes referred to as psychosocial supports, complement clinical services by aiming to achieve positive improvements in functioning. Non-clinical support services include services to support engagement with education, training and employment; help individuals find and maintain stable housing; provide opportunities for social interaction and community engagement; support development of independent living skills; and improve physical health. Aims: The objective of this thesis was to generate evidence to inform planning for non-clinical support services for young adults with mental disorders in Australia. The thesis had two core aims: 1. Identify the types of mental health services that should be available to young adults with mental disorders. 2. Explore methods for determining population-level need for non-clinical support services among young adults with mental disorders. Methods: First, an iterative multi-methods study (Chapter Three) was undertaken to develop a framework for the key mental health service components required to provide developmentally appropriate care to young adults. This process involved targeted examinations of the peer reviewed and grey literature, a series of meetings with a national panel of experts in youth mental health, and supplementary stakeholder consultation. A systematic review (Chapter Four) was then conducted to examine the effectiveness of the key non-clinical service components, identified in Chapter Three, at improving functional outcomes. The results of Chapters Three and Four provided a framework of evidence on the effectiveness of key mental health services required for young adults. Chapter Five sought to build on this evidence by estimating the population-level need for non-clinical support services which are needed to inform service planning decisions. Consensus building methods (structured consultation with an expert panel and an online Delphi survey) were used in a case study to demonstrate how population level need for lifestyle interventions among young adults with mental disorders could be quantified. A final study (Chapter Six) was undertaken to gather in-depth insights from young adults on their experiences with non-clinical support services, including perceived benefits, barriers to care, and enablers of service access.Results: Seven key service components were identified as being important for developmentally appropriate mental health care for young adults (Chapter Three). Five had a non-clinical focus: vocational support, youth development, peer support, lifestyle interventions, and family and network support. A systematic review (Chapter Four) identified seventeen studies that examined the impacts that these non-clinical service components had on functional outcomes among young adults. There were nine vocational support studies; results showed positive employment outcomes and, where measured, some improvements in other outcomes such personal recovery and quality of life. There were six lifestyle intervention studies; mixed results (positive and negative) were reported for the variety of functional outcomes measured in these studies. There were two studies on family and network support services; neither showed convincing evidence for effectiveness on improving functional outcomes. No studies reporting on functional outcomes associated with peer support or youth development services were identified through the systematic search. Research aiming to translate evidence on ‘what services work’ into pragmatic guidance to help inform service planning and research allocation was undertaken using lifestyle interventions as a case study (Chapter Five). Operational considerations for the design and planning of lifestyle interventions were identified. These included: the need for both individual and group-based services, that the duration of contact required varies with severity of illness, and that there is need for a multidisciplinary team-based workforce. There was a high level of discordance on the estimated population-level need for lifestyle interventions between approaches. The Delphi survey produced significantly higher estimates across all sub-groups compared to the Panel. Eight important themes relating to the effectiveness of non-clinical support services and barriers and enablers to accessing these services were identified from engagement with young adults (Chapter Six). Use of these services was found to create opportunities for social connections, provide support for personal development during the transition to adulthood, provide young adults with ways to relax and express feelings, and achieve a sense of accomplishment. Areas to consider when attempting to increase access to services included enhancing awareness of services, ensuring services are developmentally appropriate, addressing costs and location barriers. Conclusion: This thesis highlights that non-clinical support services have an important role to play in improving functional outcomes among young adults with mental disorders. They offer a complementary focus to clinical services (which focus on reduction in psychiatric symptoms) and should be incorporated into integrated models of youth mental health care. Findings from this thesis have already been incorporated into a national planning framework for mental health services to guide better planning and investment for nonclinical support services. Future quantitative and qualitative research on how these services help to address areas of functioning important to young adults will help to strengthen the evidence base further.