Engagement in Mental Health Services Among Young Adults with Serious Mental Illnesses

Introduction: Transition-age youth have high rates of mental illness, and often choose not to continue treatment in young adulthood (Institute of Medicine and National Research Council, 2015). Previous research has shown that thoughts and emotions, coupled with environmental constraints (i.e., time) are barriers to young adult engagement (Munson et al., 2012; Dixon et al., 2017). And yet, there are no evidence-based engagement interventions developed to address this critical issue. The meta-intervention described in this paper was designed with young adults with severe mental health challenges (SMHC), and it uses both traditional (i.e. psychoeducation) and innovative intervention techniques (i.e., technology, narratives, and art) to communicate with and engage young adults in their mental health care. The process of engagement commences during intake at adult recovery and rehabilitation services.

Method: Improving engagement in mental health care is conceptualized and explained as an evolving process, working together with all stakeholders, while collecting and analyzing data over time. In this paper we present studies that used mixed methods, participant action research (PAR), and a developmental trial to develop, refine, and test a young adult engagement intervention. Over the years, our team has developed underlying theories of mental health engagement, alongside a communication matrix to develop an empirically-based novel intervention. At this time, we have enrolled 75 young adults with SMHC, and in this paper we will present 1) formative research; 2) development of the federally-funded NIMH trial, and 3) preliminary data on the sample and short term engagement outcomes (i.e., engagement, adherence), which are the focus of the intervention.

Results: Formative research led to an underlying theory, which illuminates empirically-based mechanisms of change for improving mental health service use. This theory suggests that multi-level factors (i.e., individual, relational, and structural) were associated with service use decisions. This subsequently led to a series of pilots, which refined the intervention. We will illustrate varying uses of pilot intervention data (i.e., measurement development). Finally, we have enrolled 75 young adults in the trial. They are, on average, 26.16 years of age. Their primary diagnoses are 65% schizophrenia-spectrum, 35% Bipolar disorder, with multiple reports of co-occurring conditions (n=15). The young adults were largely receiving services from public systems of care, social security insurance (61%), Medicaid (85%), and they reported use of foster care (18%), juvenile justice (14%) and special education (48%) during childhood. The sample is 67% male, and over 91% identify as non-white. Using single degree of freedom contrasts of those in the Just Do You group at pre- and post-test shows increased level of engagement/investment in treatment (t=-2.03, p<.05) and adherence to treatment (t=-2.77, p<.01), with hypothesized mediators (i.e., increased trust) trending toward significance (p<.15).

 Discussion:

 This study illustrates that engagement interventions in the adult system that are developed for and with young adults may lead to changes in engagement outcomes. It also suggests that working with clients, and hearing their own voices, using principals of PAR can lead to interventions in which there is young adult buy-in.