ORCID Profile
0000-0002-2535-736X
Current Organisations
University College Dublin College of Science
,
University College Cork
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Publisher: Springer Science and Business Media LLC
Date: 12-2013
Publisher: Wiley
Date: 22-12-2015
DOI: 10.1111/EIP.12303
Abstract: Youth suicide in Ireland is now the second highest in the European Union. General practitioners (GPs), as the health-care professional most often consulted by young people, have a central role in early detection of youth mental health problems. However, evidence regarding the perspectives of young people and health-care workers towards screening and treatment for such issues in primary care in Ireland is lacking. This study aimed to examine the role of GP in providing early intervention and treatment for youth mental health problems. A mixed methods study that involved qualitative interviews with health-care workers from primary care, secondary care and community agencies (n = 37) and young people (n = 20) in two of Ireland's most socioeconomically disadvantaged areas and a national cross-sectional survey of GPs (n = 175) were carried out. GP satisfaction rates were low in regard to postgraduate training received in child and adolescent mental health (17%) and substance use (21%). Key barriers to treatment included the attitude of patients/families, lack of specialist staff, poor service availability and time. Access to services (66%), knowing which interventions can be initiated in primary care (44%), having appropriate time and space (47%) and access to a youth worker (42%) were the interventions most commonly identified that would facilitate screening and treatment. The research outlined potential implications for clinical practice, research and education such as promoting awareness of mental health and the role of the GP in helping these issues, education of practitioners and improving access to psychological treatments.
Publisher: Cambridge University Press (CUP)
Date: 13-01-2015
DOI: 10.1017/IPM.2014.70
Abstract: Social context has a major influence on the detection and treatment of youth mental and substance use disorders in socioeconomically disadvantaged urban areas, particularly where gang culture, community violence, normalisation of drug use and repetitive maladaptive family structures prevail. This paper aims to examine how social context influences the development, identification and treatment of youth mental and substance use disorders in socioeconomically disadvantaged urban areas from the perspectives of health care workers. Semi-structured interviews were conducted with health care workers ( n =37) from clinical settings including: primary care, secondary care and community agencies and analysed thematically using Bronfenbrenner’s Ecological Theory to guide analysis. Health care workers’ engagement with young people was influenced by the multilevel ecological systems within the in idual’s social context which included: the young person’s immediate environment/‘microsystem’ (e.g., family relationships), personal relationships in the ‘mesosystem’ (e.g., peer and school relationships), external factors in the young person’s local area context/‘exosystem’ (e.g., drug culture and criminality) and wider societal aspects in the ‘macrosystem’ (e.g., mental health policy, health care inequalities and stigma). In socioeconomically disadvantaged urban areas, social context, specifically the micro-, meso-, exo-, and macro-system impact both on the young person’s experience of mental health or substance use problems and services, which endeavour to address these problems. Interventions that effectively identify and treat these problems should reflect the additional challenges posed by such settings.
Publisher: Emerald
Date: 05-12-2016
Abstract: Problem alcohol use (PAU) is common and associated with considerable adverse outcomes among patients receiving opioid agonist treatment (OAT). The purpose of this paper is to describe a qualitative feasibility assessment of a primary care-based complex intervention to promote screening and brief intervention for PAU, which also aims to examine acceptability and potential effectiveness. Semi-structured interviews were conducted with 14 patients and eight general practitioners (GPs) who had been purposively s led from practices that had participated in the feasibility study. The interviews were transcribed verbatim and analysed thematically. Six key themes were identified. While all GPs found the intervention informative and feasible, most considered it challenging to incorporate into practice. Barriers included time constraints, and overlooking and underestimating PAU among this cohort of patients. However, the intervention was considered potentially deliverable and acceptable in practice. Patients reported that (in the absence of the intervention) their use of alcohol was rarely discussed with their GP, and were reticent to initiate conversations on their alcohol use for fear of having their methadone dose reduced. Although a complex intervention to enhance alcohol screening and brief intervention among primary care patients attending for OAT is likely to be feasible and acceptable, time constraints and patients’ reticence to discuss alcohol as well as GPs underestimating patients’ alcohol problems is a barrier to consistent, regular and accurate screening by GPs. Future research by way of a definitive efficacy trial informed by the findings of this study and the Psychosocial INTerventions for Alcohol quantitative data is a priority. To the best of the knowledge, this is the first qualitative study to examine the capability of primary care to address PAU among patients receiving OAT.
Publisher: Wiley
Date: 23-06-2014
DOI: 10.1111/EIP.12165
Abstract: To examine the experience of developing and living with mental health and substance use disorders among young people living in urban-deprived areas in Ireland to inform primary care interventions. Semi-structured qualitative interviews with 20 young adults attending health and social care agencies in two deprived urban areas, and analysed using thematic analysis. Five themes were identified: experiencing symptoms, symptom progression, delay accessing help, loss of control/crisis point, and consequences of mental health and substance use disorders. As young people delayed help, symptoms disrupted normal life progression and they found themselves unable to engage in everyday activities, and living with reduced potential. Living in deprived areas influenced the development of problems: many had added stressors, less familial support and early exposure to violence, addiction and bereavement. Young people in urban-deprived areas are especially vulnerable to mental health and substance use disorders. Early identification in primary care appears necessary in halting symptom and illness progression, improving young people's chances of achieving their potential.
Publisher: Springer Science and Business Media LLC
Date: 05-11-2016
Publisher: Springer Science and Business Media LLC
Date: 06-09-2014
DOI: 10.1007/S11845-014-1187-Z
Abstract: GPs, as healthcare professionals with whom young people commonly interact, have a central role in early intervention for mental health problems. However, successfully fulfilling this role is a challenge, and this is especially in deprived urban areas. To inform a complex intervention to support GPs in this important role, we aim to identify the key areas in which general practice can help address youth mental health and strategies to enhance implementation. We conducted a modified Delphi study which involved establishing an expert panel involving key stakeholders/service providers at two deprived urban areas. The group reviewed emerging literature on the topic at a series of meetings and consensus was facilitated by iterative surveys. We identified 20 in idual roles in which GPs could help address youth mental health, across five domains: (1) prevention, health promotion and access, (2) assessment and identification, (3) treatment strategies, (4) interaction with other agencies/referral, and (5) ongoing support. With regard to strategies to enhance implementation, we identified a further 19 interventions, across five domains: (1) training, (2) consultation improvements, (3) service-level changes, (4) collaboration, and (5) healthcare-system changes. GPs have a key role in addressing youth mental health and this study highlights the key domains of this role and the key components of a complex intervention to support this role.
No related grants have been discovered for Dorothy Leahy.