Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
Please could you outline the recent study into youth mental health in Mid-West Ireland?
Ireland, and many other countries, is witnessing increases in problematic and complex youth mental health challenges. In Ireland, specifically, there has been a rash of high profile cases where young people have unfortunately not been able to deal with stress, bullying and other issues.
We wanted to determine what interaction general practitioners were having with young people, number of visits, reasons for visits, outcomes, referrals to specialist care, etc.
We surveyed 128 clinicians and analysed their responses. The conclusions were that mental health and family conflict represented the most frequent reasons why young people attended GPs.
Depression, anxiety, family conflict, suicidal thoughts/behaviour, and attention deficit hyperactivity disorder (ADHD) were the most common issues followed by substance abuse and antisocial behaviours.
What did this study find?
The take-home message was that young people have to deal with mental health problems. And they don’t always know where to get help. They don’t always recognise that GPs are a resource to be accessed.
Also, from the perspective of GPs, they do not always have the required expertise/training to treat with mental health conditions in young people and, at least in this region, can find it difficult to access appropriate specialist services.
Why do think young people don’t always know where to get help for mental health problems?
There is a stigma associated with mental illness. In many cases, young people use internet resources that can be accessed in private rather than discussing their problems with peers or family. As a result, they may not always become aware of local groups or programmes as these sometimes lack the ability to promote themselves or to develop a web presence and, so, troubled young people may instead encounter only national or regional help groups. More specifically, young people may see GPs as those they go to see with a “medical” ailment and do not necessarily recognise the local doctor as someone they can discuss their angst or mental discomfort with.
Why do GPs not always have the required expertise to treat mental health conditions in young people?
This is a complex question. The recognition of mental health challenges in young people and the degree with which these are seen in GP practice are relatively new. It is reasonable to speculate that recently-graduated GPs may have studied this topic in curricula of their medical school and postgraduate courses to a greater degree than those who have been in practice for longer. That said, continuing professional education opportunities are being developed and their availability/requirement will change the situation considerably.
How did the findings of your study compare to the reasons why adults most frequently attend GPs?
We have not completed a study of adult mental health support in our region. But, it is realistic to say that while conventional wisdom may have been that young people do not face the same stresses as adults (due to familial protection, financial and psychological/emotional support of parents, siblings, friends, teachers, etc), the emerging picture is one of young people encountering both similar and quite different pressures.
What changes do you think have led to an increase in complex youth mental health challenges?
This is a matter for both public health and socioeconomic experts. But, anecdotally, two issues come to mind quickly. Firstly, stresses associated with the rapid decline of Ireland’s economic health leading to pessimism regarding future careers and even ability to build an adult life in Ireland versus potential emigration and, secondly, cyber-bullying and the impact of pervasive social media are two factors. Neither of these are limited to Ireland’s youth, and the results of our study are probably mirrored widely.
What impact do you think the findings of your study will have?
We have already had contact from specialist service providers interested in understanding this environment and in attempting to deliver their (often youth-specific) services.
As discussions develop we hope that young people who have previously been unable to benefit from specialist care will be able to do so. Similarly, we would hope that postgraduate and continuing professional development opportunities in this field will be made available to GPs in the region.
Will this avenue of research continue?
Our research programmes at the Centre for Interventions in Infection, Inflammation & Immunity (www.4i.ie) bring together the resources of university-, primary care- and hospital-based investigators. All of our programmes focus on real-life problems identified at the coal face of clinical practice and aim to develop workable solutions for these.
In summary, a major focus of 4i is the translation of research findings into better patient outcomes and improved effectiveness, efficiency, and economics in healthcare provision.
With respect to this work specifically, the team based at 4i and led by Prof Cullen has secured national funding to progress studies addressing alcohol and youth mental health.
Most recently, the group launched a feasibility study of interventions for patients in the region who have both alcohol and illicit drug addictions. The capabilities developed in that programme and associated resources will complement the youth mental health team.
Where can readers find more information?
About Professor Colum Dunne
Professor Colum Dunne (BSc, PhD, MBA) was educated at University College Cork (UCC). Colum has held senior research roles at Ireland's National Food Biotechnology Centre, and UCC's BioMerit Research Centre & Departments of Microbiology and Medicine.
Following a period as General Manager of a cancer research centre focused on development of gene-/chemotherapies and innovative medical devices, Colum joined Glanbia plc as Director of Research and served as a member of the Boards of the Glanbia Nutritionals group of companies.
Colum was also Director of Westgate Biologicals Ltd, a start-up antimicrobial business. Colum has published extensively and is an inventor on a number of commercialised patents.
He is a Fellow of Royal Academy of Medicine in Ireland and the Royal Society of Medicine (London).
He is currently Director of Research at the Graduate Entry Medical School, and Founding Director of the Centre for Interventions in Infection, Inflammation, and Immunity (4i) at the University of Limerick, Ireland. Colum is also a member of the University’s Governing Authority.