Youth mental health service lacks continuity of care

While the government’s mental health service for children and young people is generally considered to be of high quality, its users are concerned about the lack of continuity of care and the unreasonably long waiting times for an appointment, a recent survey has found.

The findings emerged from a 2018 study by psychiatrists Andrea Saliba and Nigel Camilleri, which analysed the responses of 211 young people – with an average age of just under ten years and who attended the Children and Young Persons Support Services in November 2015 – to an evaluation survey of the service. CYPS is a government service aimed at offering help to children, adolescents and their families who are facing difficulties in their life, and through which workers in the field meet with young people, develop treatment and care plans, and offer support.

All participants to the survey, which was the first user satisfaction evaluation carried out for CYPS, were under 18 and were classified as having a mental disorder according to ICD-10 (International Statistical Classification of Diseases and Related Health Problems).

Respect for treatment opinions

Overall, the survey documented positive feedback from the young people about the quality of the service, with 73% saying the level of help offered was excellent or very good. Almost 70% said the overall quality was excellent or very good.

When it came to the respect shown for the young people’s opinions about treatment, and to the matching of treatment plans to individual needs, 69% and 63% respectively of the survey’s respondents gave ratings of excellent or very good.

The overall quality of care, the survey showed, was significantly correlated with the respect shown for the young people’s opinions on treatment, to the matching of the treatment plan to their needs, and to the helpfulness of the service.

Overall, the survey documented positive feedback from the young people about the quality of the service, with 73% saying the level of help offered was excellent or very good

Continuity of care absent

The survey, however, highlighted the respondents’ concern on the absence of continuity of care, making it difficult to establish a therapeutic relationship between clinicians and young persons.

The study argued that this could be the result of the nature of the system, where young people receiving care are reviewed by a different doctor at each visit to CYPS. One way of addressing this would be to assign each clinician their own caseload, allowing them to follow the youngster’s progress from start to end.

If a young person’s individual needs and treatment plans are matched, that person would feel the service was helpful, and this would significantly predict the overall quality of care, the study indicated.

CYPS’ opening hours were identified as a possible issue, since appointments are all given during school hours, indirectly forcing young people to choose between attending classes or visiting the clinic.

Another restrictive factor is that referrals to CYPS can only be made by doctors, with professionals working in mental health and education, and caregivers themselves, unable to refer directly to the service. Since research shows that less than half of young people with a mental disorder actually access a mental health service, making the referral process easier would increase access rates, the study proposed.

Survey results show that young people would prefer having small community service centres, instead of one centralised service for the whole of Malta.

Waiting times too long

Over 12% of young people surveyed – a substantial number – commented that waiting times for appointments were too long. In 2014, a different evaluation of waiting times at CYPS found that the average time for a first specialist review was over 300 days.

“Therefore, CYPS waiting times did not follow guidelines recommended by NHS Scotland’s Local Delivery Plan Standards, which indicates that a child should not wait for more than 18 weeks from referral to treatment,” the study said.

Increasing the trained staff to patient ratio, investing in treatment pathways with target waiting times and auditing the service regularly could help reduce waiting times, it suggested.

Parking facilities available at CYPS meeting locations were rated poorly, with 53% saying the availability of parking was poor, and less than 2% rating it as excellent.

Survey respondents also emphasised that the different services in the field need to communicate better between themselves. This has started being addressed by the CYPS, the study noted, with its staff now carrying out more school visits, aiming to liaise with the educational system and assess young people in their “natural environment”. This should provide a better understanding of their needs and lead to a better outcome for the care provided.

More attention is being placed on communication between paediatricians and clinicians working at CYPS, with forward strides being made in this area through the use of exchange training placement programmes between psychiatry and paediatrics trainees.

Environment not up to scratch

The CYPS clinic’s environment emerged as another theme in survey respondents’ comments.

Young persons pointed out that the service centre’s aesthetic wasn’t appropriate for people their age, and noted in the survey the need for a “happy looking”, “well-lit” and “comfortable” environment.

The study said that relatively small changes, such as having artwork on display, could help change the general perception of the service. It also suggested that static exercise bikes could be placed in the waiting rooms, to be used by young people to charge their phones while waiting, and at the same time address the obesity problem on the island.

The authors hypothesised, through the information gathered, that a “substantial number” of young people in Malta choose to access private mental health services instead of the state provided CYPS.

“This would be the result of the poor environment and location of the service centre, the unacceptably long waiting lists, and the lack of possibility to engage with the same professional,” the study said, adding that the possibility of self-referrals could also be making independent mental health services appear more attractive.​