Mental Health Service Use Experiences of Former System Youth with Psychiatric Difficulties

Background/Purpose: System involved youth commonly experience changes in their mental health service use as they become adults (McMillen & Raghavan, 2009). Yet, little is known about reasons for termination of services and/or how youth maintain or reestablish service connection. This study addresses this gap by asking: 1) How many young adults served by the children's mental health system transition to adult services?; 2) What are common routes to adult services?; 3) What facilitates or creates barriers to service use transition?; and 4) How does young adult service use compare and contrast with existing models (e.g. Anderson & Newman, 1973; Stiffman, Pescosolido & Cabassa, 2004)?

Methods: Three analysts utilized immersion/crystallization (Borkan, 1999) and the constant comparative method (Boeije, 2002) to explore service use among 50 Midwestern young adults (Mean Age=22) with childhood histories that included a mood disorder, publicly-funded mental health service use, and use of at least one additional public system of care (Mean=3.3 systems). Three hour in-depth interviews were conducted regarding transitioning to adulthood with mood and emotional difficulties. Initial impressions and existing theory were utilized to develop an a priori template of codes. Investigators independently coded interviews with the template, adding new codes as necessary and meeting numerous times to discuss codes, grouped codes, emerging themes and relationships between and among themes until consensus was reached. Investigators then went back and immersed themselves in the data to further understand youth's service use more holistically. Member checking and triangulation were utilized to enhance study rigor.

Findings: Seventy-two percent of participants utilized mental health services at some point in adulthood; only 22% utilized services continuously across the transition. Three service use pathways emerged: 1) Continuous, 22%, 2) Single or multiple Interruptions, 50%, and, 3) Discontinuous, 28%. Data suggests individual (e.g., knowledge of services) relational (e.g., relationship quality with providers) and system factors (e.g., delays in access) contributed to either continued connection or disconnection from care. Common routes to adult services included experiencing crises and becoming a parent. The present study illuminated this is a time when young adults report losing gateway providers (“…my depression was more maintained when I was in foster care…then versus being out on your own and there's nobody really forcing you to go help yourself, like help you get help for your depression. It's just all on you...”). In order to access care, knowledge and perception of need, which have been demonstrated as crucial for gateway providers in the Stiffman et al. model, emerged as codes critical to young adults themselves.

Conclusions/Implications: This research extends literature on mental health service use among young adults, specifically describing the routes former system youth travel in and out of care. Translating the identified facilitators and barriers and implementing them as intervention points for improving continuity and quality of care may increase access and service utilization. Further, data suggests service use models for young adults must attend to the presence/absence and quality of gateway providers, while also examining the internalization of perceived need and knowledge within the young adults' themselves.