Department of Psychiatry, McGill University, Montreal, Canada.
Douglas Research Centre, Montreal, Canada.
Soc Psychiatry Psychiatr Epidemiol. 2021 Mar;56(3):339-361. doi: 10.1007/s00127-020-01976-9. Epub 2020 Nov 18.
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.
全球范围内，人们对年轻人心理健康的日益关注促使人们努力改革精神卫生服务。此类改革需要充分了解年轻人及其照顾者在寻求精神卫生帮助时的经历。为了深入了解这一点，我们对年轻人及其照顾者在精神卫生系统中寻求帮助的经历进行了元分析。我们在五个电子数据库（Medline、PsycINFO、EMBASE、CINAHL 和 HealthSTAR）中进行了检索。纳入的研究必须符合以下条件：探讨 11-30 岁人群及其照顾者寻求精神卫生服务途径的经验；以英文或法文发表；采用定性方法。使用 CASP 工具对研究质量进行评估。综合 31 项纳入研究得出了三个主题：与精神卫生服务的初步接触；服务响应的特征；以及年轻人和照顾者对服务的评价。与初步接触相关的主题包括心理健康素养、结构性障碍和社会支持。与服务响应相关的主题包括复杂的途径、等候名单、资格和碎片化护理。在服务评估方面，积极的接触体现在可及性和关怀感知方面。负面评价源于感到被误解和排斥，以及对治疗信息了解不足。无论诊断和环境如何，年轻人和照顾者在获得精神卫生保健方面都面临困难。尽管影响寻求护理途径的个体、社会和医疗保健因素各不相同，但系统的复杂性是一个共同的障碍。本次综合分析为改善精神卫生服务和年轻人的服务途径提供了建议。它强调了在改革中必须立足于年轻人及其照顾者的观点和需求。
