Introduction
Adolescence represents a critical life stage in which there is rapid physical, cognitive and psychosocial development.1 It is the time where the patterns and foundations for future health are laid and thus presents a unique opportunity to promote health and subsequently improve life-long wellbeing and reduce health inequalities.1–3 Historically, this age group has attracted less policy interest and investment.4 In addition to the health benefits of investing in adolescents and young adults (AYAs), there are economic advantages as well as the possibility of greater societal gains.2–3 Mental health problems represent the greatest contributors to disease burden for this population and this contribution is forecast to rise.5 The NHS Long Term Plan states that by 2028 we should move towards service models for AYAs that are person-centred and offer age-appropriate care for physical and mental health needs.6 Furthermore, the World Health Organization states that AYAs need health services that are supportive, equitable and effective.1 The project aims to scope out AYA care at London North West University Healthcare NHS Trust (LNWH) with a view to improve quality of care for this group of patients.
Materials and methods
Quantitative data were obtained and used to assess patterns of presentation to the emergency department (ED). Qualitative data was obtained through stakeholder interviews with healthcare professionals, AYA patients and their caregivers. As of January 2022, 113 stakeholders were interviewed. The data obtained informed the creation of the ‘LNWH AYA Manifesto’ (Fig 1). This was converted into a questionnaire for all professionals involved in the care of AYA patients to assess organisational culture around AYA care.
The ‘LNWH AYA Manifesto’.
Results and discussion
It was found that AYA care at LNWH lies across a complex cross-sector system. The commonest code for presentation to the ED for those ages 13 to 25 was ‘depressive disorder’. Key themes from stakeholder interviews included the following:
AYAs are not always provided with age-appropriate care.
Acute trusts may serve as a catalyst for change for AYA patients and youth workers may be better placed to connect with them
There is a need for an integrated approach to physical and mental health, with better relationships needed between the acute teams and CAMHS.
The ‘LNWH AYA Manifesto’ questionnaire found disparate opinions regarding the approach to integrated physical and mental health; of the 47 responses obtained, 25.6% reported not feeling confident with recognising and managing mental health and social issues in AYAs and 44.7% believed that physical and mental health problems should be addressed separately by the relevant specialties.
Conclusion
AYA care lies across a complex cross-sector system and thus requires a multifactorial approach to create a culture change towards recognising the distinct needs of this population. One such intervention proposed is the introduction of a youth worker outreach model similar to the King's Adolescent Outreach Service as a way to create a shift towards an integrated approach to physical and mental health care.6,7
- © Royal College of Physicians 2022. All rights reserved.
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