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Publication Detail
Adolescent Mental Health and Mental Health Services: A Mixed Methods Investigation
  • Publication Type:
  • Authors:
    Quinlan-Davidson M
  • Date awarded:
  • Awarding institution:
    UCL (University College London)
  • Language:
Mental health symptoms largely emerge during childhood, adolescence, and young adulthood, with estimates suggesting that by 25 years of age, 62% of all mental health disorders have appeared. These conditions are the largest contributors to the burden of disease during adolescence (10-19 years), and are exacerbated in resource-limited environments where the majority of the world’s adolescents live. Adolescent mental health is influenced by (i) their needs (mental health problems; risk and protective factors; and social determinants); and (ii) actions through mental health services; structural (policies) and the community (multisectoral strategies). In São Paulo city, Brazil, the site of this thesis, the prevalence of common mental disorders among adolescents (15-19 years) was estimated at 13.2% in 2015. Meanwhile, levels of social inequality, violence and poverty are high. No study to date has been conducted in São Paulo investigating adolescent mental health needs and how health services are responding to these needs, particularly in limited resource and violent neighbourhoods. This mixed methods thesis bridges this gap and aims to provide an opportunity to better understand how adolescent mental health services are delivered and responding to adolescents’ mental health needs within this context. The study involved a systematic review of the global literature on quality in adolescent mental health services, identifying aspects and challenges to quality in adolescent mental health service provision. It also involved a secondary data analysis of adolescents (n=2,702) in secondary schools across São Paulo to investigate mental health needs among adolescents and how these needs relate to the local contexts within which quality in mental health service is provided. Finally, semi-structured interviews among health care providers (n=45) were conducted in limited-resource and violent settings in south west São Paulo city to explore providers’ perception of quality, barriers and facilitators to the provision of adolescent mental health services in primary and secondary facilities. The analysis and interpretation of findings led to the evaluation of potential interventions, including the standardisation of quality and methods to measure quality; the conceptualisation of a navigation pathway to quality adolescent mental health services; policy implications that promote social support; and recommendations on better integration of primary health services in adolescent mental health care.
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