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      Youth Mental Health Should Be a Top Priority for Health Care in Canada

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          Abstract

          <p class="first" id="d4581876e236">In this article we have provided a perspective on the importance and value of youth mental health services for society and argued that advancing youth mental health services should be the number one priority of health services in Canada. Using the age period of 12–25 years for defining youth, we have provided justification for our position based on scientific evidence derived from clinical, epidemiological and neurodevelopmental studies. We have highlighted the early onset of most mental disorders and substance abuse as well as their persistence into later adulthood, the long delays experienced by most help seekers and the consequence of such delays for young people and for society in general. We have also provided a brief review of the current gross inadequacies in access and quality of care available in Canada. We have argued for the need for a different conceptual framework of youth mental disorders as well as for a transformation of the way services are provided in order not only to reduce the unmet needs but also to allow a more meaningful exploration of the nature of such problems presenting in youth and the best way to treat them. We have offered some ideas based on previous work completed in this field as well as current initiatives in Canada and elsewhere. Any transformation of youth mental health services in Canada must take into consideration the significant geographic, cultural and political diversity across the provinces, territories and indigenous peoples across this country. </p>

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          Most cited references44

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          Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review.

          Duration of untreated psychosis (DUP) is the time from manifestation of the first psychotic symptom to initiation of adequate treatment. It has been postulated that a longer DUP leads to a poorer prognosis. If so, outcome might be improved through earlier detection and treatment. To establish whether DUP is associated with prognosis and to determine whether any association is explained by confounding with premorbid adjustment. The CINAHL (Cumulative Index to Nursing and Allied Health), EMBASE, MEDLINE, and PsychLIT databases were searched from their inception dates to May 2004. Eligible studies reported the relationship between DUP and outcome in prospective cohorts recruited during their first episode of psychosis. Twenty-six eligible studies involving 4490 participants were identified from 11 458 abstracts, each screened by 2 reviewers. Data were extracted independently and were checked by double entry. Sensitivity analyses were conducted excluding studies that had follow-up rates of less than 80%, included affective psychoses, or did not use a standardized assessment of DUP. Independent meta-analyses were conducted of correlational data and of data derived from comparisons of long and short DUP groups. Most data were correlational, and these showed a significant association between DUP and several outcomes at 6 and 12 months (including total symptoms, depression/anxiety, negative symptoms, overall functioning, positive symptoms, and social functioning). Long vs short DUP data showed an association between longer DUP and worse outcome at 6 months in terms of total symptoms, overall functioning, positive symptoms, and quality of life. Patients with a long DUP were significantly less likely to achieve remission. The observed association between DUP and outcome was not explained by premorbid adjustment. There is convincing evidence of a modest association between DUP and outcome, which supports the case for clinical trials that examine the effect of reducing DUP.
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            Excess mortality of mental disorder

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              Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication.

              An understudied crucial step in the help-seeking process is making prompt initial contact with a treatment provider after first onset of a mental disorder. To provide data on patterns and predictors of failure and delay in making initial treatment contact after first onset of a mental disorder in the United States from the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey carried out between February 2001 and April 2003. A total of 9282 respondents aged 18 years and older. Lifetime DSM-IV disorders were assessed with the World Mental Health (WMH) Survey Initiative version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured interview designed to be administered by trained lay interviewers. Information about age of first professional treatment contact for each lifetime DSM-IV/WMH-CIDI disorder assessed in the survey was collected and compared with age at onset of the disorder to study typical duration of delay. Cumulative lifetime probability curves show that the vast majority of people with lifetime disorders eventually make treatment contact, although more so for mood (88.1%-94.2%) disorders than for anxiety (27.3%-95.3%), impulse control (33.9%-51.8%), or substance (52.7%-76.9%) disorders. Delay among those who eventually make treatment contact ranges from 6 to 8 years for mood disorders and 9 to 23 years for anxiety disorders. Failure to make initial treatment contact and delay among those who eventually make treatment contact are both associated with early age of onset, being in an older cohort, and a number of socio-demographic characteristics (male, married, poorly educated, racial/ethnic minority). Failure to make prompt initial treatment contact is a pervasive aspect of unmet need for mental health care in the United States. Interventions to speed initial treatment contact are likely to reduce the burdens and hazards of untreated mental disorder.
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                Author and article information

                Journal
                The Canadian Journal of Psychiatry
                Can J Psychiatry
                SAGE Publications
                0706-7437
                1497-0015
                March 11 2018
                April 2018
                March 11 2018
                April 2018
                : 63
                : 4
                : 216-222
                Affiliations
                [1 ]Department of Psychiatry, McGill University, Montreal, QC, Canada
                [2 ]Douglas Mental Health University Institute, Verdun, QC, Canada
                [3 ]ACCESS Open Minds Network, Montreal, QC, Canada
                [4 ]Program of Early intervention and Prevention of Psychoses, Montreal, QC, Canada
                [5 ]Department of Family, Medicine, McGill University, Montreal, QC, Canada
                [6 ]Community Information and Epidemiological Technologies (CIET) Institute and Participatory Research at McGill (PRAM), Montreal, QC, Canada
                [7 ]McGill Institute of Human Development and Well-being, McGill University, Montreal, QC, Canada
                [8 ]School of Rehabilitation, Faculty of Medicine, University of Montreal, QC, Canada
                [9 ]Health Innovation and Assessment Hub, University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
                [10 ]Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
                Article
                10.1177/0706743718758968
                5894919
                29528719
                8f020b16-0b82-4312-8097-b0165c40a2bb
                © 2018

                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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