Catanzano, Matteo; (2021) Increasing access to evidence-based mental health treatments for paediatric hospital patients: development and evaluation of a mental health drop-in centre. Doctoral thesis (Ph.D), UCL (University College London).

Abstract

Children and young people (CYP) with long-term physical conditions (LTC) have significantly elevated mental health needs. Currently few children obtain effective mental health treatments in the context of LTCs, and ways to improve access to evidence-based mental health interventions are urgently needed. One approach is to deploy briefer, more economical, yet still evidence-based, treatments through a mental health drop-in centre. The aim of the thesis was to use quantitative, qualitative and health economic methods to develop, evaluate and disseminate a mental-health drop-in centre in a paediatric hospital. It starts with an introduction to the area of mental health needs in CYP with LTCs and the need for accessible, brief, effective interventions and considers them within the MRC Framework for the Development and Evaluation of Complex Interventions (Chapter 1). The second chapter reports on a systematic review and meta-analysis of the published evidence evaluating the efficacy of brief interventions targeting psychiatric disorders in CYP with LTCs (Chapter 2). The review and subsequent meta-analysis based on 425 CYP, suggested there was preliminary evidence that brief interventions, based on cognitive behavioural principles, may benefit CYP with elevated mental health symptoms in the context of an LTC. This work indicated the potential value of a mental health drop-in centre in a paediatric hospital offering accessible, brief assessment and treatment for patients and their families. Such a centre was provided in the reception area of a tertiary hospital (Great Ormond Street Hospital) and baseline characteristics of those attending the centre over the course of the pilot year (n=82) are described (Chapter 3). A considerable proportion of paediatric hospital patients and their parents scored in the clinical range for common mental health problems, demonstrating the need for psychological interventions. Evaluation of the impact of the mental-health centre with a sample of 156 showed that attendance was associated with a reduction in emotional and behavioural symptoms and improved quality of life in the children and their parents (Chapter 4). A subset of participants (n=31) participated in a qualitative study about their experiences of taking part in the intervention and reported they found the intervention acceptable (Chapter 5). To gather preliminary evidence on the cost-effectiveness of the intervention, a cost-utility analysis was conducted. These preliminary findings suggest that when measuring outcomes using a quality of life measure, the drop-in centre is cost-effective (Chapter 6). In order to facilitate broader dissemination and implementation of the intervention we evaluated a 'low-intensity therapy training day’ for staff and hospital volunteers (n=24). Findings showed that the one-day low-intensity training day increased knowledge and understanding in all key areas measured, and was positively received, supporting potential future implementation (Chapter 7). The thesis ends with a synthesis of the findings in the context of the MRC Framework and makes suggestions for future research including the need for a randomised controlled trial (Chapter 8). It is concluded that mental health drop-in centres in paediatric hospitals have the potential to provide accessible, acceptable, effective interventions to vulnerable families at the point of need.

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