The societal toll and human misery associated with mental health disorders is well established. Nonetheless, only about one in five minors with mental health difficulties access adequate... Show moreThe societal toll and human misery associated with mental health disorders is well established. Nonetheless, only about one in five minors with mental health difficulties access adequate professional support. Care pathways and procedures have to facilitate timely recognition and adequate evaluation of patients’ needs to navigate those who can benefit towards ‘the right service in the right place, at the right time, and delivered by the right person’ - a meaningful Chinese proverb often used by authors from the field of healthcare. To reach this meaningful goal, professionals should be able to ‘look’ at a patient and ‘see’ patients’ needs. This by relying on their sufficient knowledge to recognize a probable mental health need, their skills and experience to enquire further, known methods to reliably assess strengths and weaknesses, and readily available resources to translate what they see into an adequate support or management plan. In this PhD thesis we present a series of studies aimed to fill gaps in empirical knowledge on this topic of recognition, assessment, and referral of youth with mental health problems at the interface of primary care and mental healthcare. The results of the studies could inform clinicians on the status quo considering recognition and referral of minors with mental health problems. Moreover, the findings could serve policy and curriculum makers, thereby improving effective practices in child and adolescent mental healthcare. Show less
Although referral letters (RLs) form a nodal point in a patient's care journey, little is known about their informative value in child and adolescent mental healthcare. To determine the informative... Show moreAlthough referral letters (RLs) form a nodal point in a patient's care journey, little is known about their informative value in child and adolescent mental healthcare. To determine the informative value of RLs to child and adolescent psychiatry, we conducted a chart review in medical records of minors registered at specialized mental healthcare between January 2015 and December 2017 (The Netherlands). Symptoms indicated in RLs originating from general practice (N = 723) were coded and cross-tabulated with the best estimate clinical classifications made in psychiatry. Results revealed that over half of the minors in the sample were classified in concordance with at least one reason for referral. We found fair to excellent discriminative ability for indications made in RLs concerning the most common psychiatric classifications (95% CI AUC: 60.9-70.6 for anxiety disorders to 90.5-100.0 for eating disorders). Logistic regression analyses suggested no statistically significant effects of gender, age, severity or mental healthcare history, with the exception of age and attention deficit hyperactivity disorders (ADHD), as RLs better predicted ADHD with increasing age (OR = 1.14, 95% CI 1.03-1.27). Contextual problems, such as difficulties studying, problems with parents or being bullied were indicated frequently and associated with classifications in various disorder groups. To conclude, general practitioners' RLs showed informative value, contrary to common beliefs. Replication studies are needed to reliably incorporate RLs into the diagnostic work-up. Show less
