title: Primary care and youth mental health in Ireland: qualitative study in deprived urban areas.
abstract: BACKGROUND
  Mental disorders account for six of the 20 leading causes of disability worldwide with a very high prevalence of psychiatric morbidity in youth aged 15-24 years. However, healthcare professionals are faced with many challenges in the identification and treatment of mental and substance use disorders in young people (e.g. young people's unwillingness to seek help from healthcare professionals, lack of training, limited resources etc.) The challenge of youth mental health for primary care is especially evident in urban deprived areas, where rates of and risk factors for mental health problems are especially common. There is an emerging consensus that primary care is well placed to address mental and substance use disorders in young people especially in deprived urban areas. This study aims to describe healthcare professionals' experience and attitudes towards screening and early intervention for mental and substance use disorders among young people (16-25 years) in primary care in deprived urban settings in Ireland.
  
  
  METHODS
  The chosen method for this qualitative study was inductive thematic analysis which involved semi-structured interviews with 37 healthcare professionals from primary care, secondary care and community agencies at two deprived urban centres.
  
  
  RESULTS
  We identified three themes in respect of interventions to increase screening and treatment: (1) Identification is optimised by a range of strategies, including raising awareness, training, more systematic and formalised assessment, and youth-friendly practices (e.g. communication skills, ensuring confidentiality); (2) Treatment is enhanced by closer inter-agency collaboration and training for all healthcare professionals working in primary care; (3) Ongoing engagement is enhanced by motivational work with young people, setting achievable treatment goals, supporting transition between child and adult mental health services and recognising primary care's longitudinal nature as a key asset in promoting treatment engagement.
  
  
  CONCLUSIONS
  Especially in deprived areas, primary care is central to early intervention for youth mental health. Identification, treatment and continuing engagement are likely to be enhanced by a range of strategies with young people, healthcare professionals and systems. Further research on youth mental health and primary care, including qualitative accounts of young people's experience and developing complex interventions that promote early intervention are priorities.
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, Ireland. Dorothy.Leahy@ul.ie.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Leahy
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schaffalitzky
authors.forename: Claire
authors.initials: C
authors.lastname: Armstrong
authors.forename: Gerard
authors.initials: G
authors.lastname: Bury
authors.forename: Paula
authors.initials: P
authors.lastname: Cussen-Murphy
authors.forename: Rachel
authors.initials: R
authors.lastname: Davis
authors.forename: Barbara
authors.initials: B
authors.lastname: Dooley
authors.forename: Blanaid
authors.initials: B
authors.lastname: Gavin
authors.forename: Rory
authors.initials: R
authors.lastname: Keane
authors.forename: Eamon
authors.initials: E
authors.lastname: Keenan
authors.forename: Linda
authors.initials: L
authors.lastname: Latham
authors.forename: David
authors.initials: D
authors.lastname: Meagher
authors.forename: Pat
authors.initials: P
authors.lastname: McGorry
authors.forename: Fiona
authors.initials: F
authors.lastname: McNicholas
authors.forename: Ray
authors.initials: R
authors.lastname: O'Connor
authors.forename: Ellen
authors.initials: E
authors.lastname: O'Dea
authors.forename: Veronica
authors.initials: V
authors.lastname: O'Keane
authors.forename: Tom P
authors.initials: TP
authors.lastname: O'Toole
authors.forename: Edel
authors.initials: E
authors.lastname: Reilly
authors.forename: Patrick
authors.initials: P
authors.lastname: Ryan
authors.forename: Lena
authors.initials: L
authors.lastname: Sanci
authors.forename: Bobby P
authors.initials: BP
authors.lastname: Smyth
authors.forename: Walter
authors.initials: W
authors.lastname: Cullen
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D007494:Ireland; D008297:Male; D008403:Mass Screening; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy; D008603:Mental Health; D008605:Mental Health Services; D011203:Poverty; D011320:Primary Health Care; D036301:Qualitative Research; D063127:Secondary Health Care; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000628:therapy; D014505:Urban Population; D055815:Young Adult