Literature Collection

Rates of poor mental health among children and young people are rising globally, with physical health professionals increasingly expected to respond to psychiatric needs. Despite this shift, limited research has explored how these professionals experience and manage mental health presentations, particularly in paediatric settings. This study examines the challenges and opportunities faced by staff supporting young people with mental health needs on paediatric hospital wards, within a system that often treats physical and mental health separately. We conducted a secondary analysis of 31 one-off semi-structured interviews, conducted with 16 mental health and 15 physical health professionals. Using reflexive thematic analysis, themes were iteratively refined in dialogue with NHS collaborators, a senior qualitative researcher, and interview participants to ensure analytic rigour and relevance. Professionals reported a widening gap between the complexity of young patients' mental health needs and the limited expertise available on physical health wards. Three themes emerged: (1) "We all feel out of our depth," reflecting feelings of being underprepared and overwhelmed; (2) "A mental health waiting room," highlighting wards being used as temporary spaces while patients await psychological care; and (3) "We're the place to keep them safe," revealing a primary focus on immediate risk management. Physical health professionals reported feeling unprepared to support young patients with mental health needs, often managing self-harm, suicidality, and eating disorders without specialist training. Both physical and mental health professionals emphasized a need for trauma-informed, non-stigmatizing communication and emotional support for staff. Barriers to integrated care within these two trusts included digital system incompatibility, understaffing, and limited psychiatric liaison. Findings highlight the urgency of cross-disciplinary training, supervision, and structural investment to support compassionate, coordinated care for young people with complex mental and physical health needs.

Primary care is crucial to the health of people with mental illness. However, there is limited information on their reported engagement in this setting. This study surveyed 100 people with mental illness who had a general practitioner or a general practitioner and a case manager from a tertiary mental health service to determine their engagement level with their GP and what interventions they received to manage their health. Forty-four per cent had their psychotropic medications primarily prescribed by their GP, and 58% reported visiting their GP for physical health problems. Ninety-four point nine percent of participants aged 50 years and over had not received government age-recommended preventive health checks. Only 62% of participants reported being screened by their GP for psychotropic side effects. Primary care plays a crucial role in providing physical and mental health care, but service users report gaps in service. The findings suggest a need to support primary care professionals further to coordinate care across primary and secondary care settings.

PURPOSE: Physical illness describes long-term physical health conditions such as asthma, diabetes, and epilepsy. Mental or neurodevelopmental disorder (MND) that co-occurs with physical illness in childhood is associated with poorer outcomes for children and their families. There is a need for contemporary estimates of physical-MND burden to inform resource allocation and reduce occurrence. This descriptive study estimated the prevalence of morbidity status and compared prevalence of MNDs among children with or without physical illness. METHODS: Data come from the 2019 Canadian Health Survey on Children and Youth, a representative cross-sectional study conducted by Statistics Canada. Physical illnesses and MNDs were reported by the person most knowledgeable about the child. RESULTS: The sample included children aged 5 to 17 years (n = 33,715). In total, 49.5% of children had at least one physical illness and 17.9% had at least one MND. Physical-MND multimorbidity was reported for 9.8% of children. Among children with any physical illness, MNDs were present in 19.9%. Among children with no physical illness, the prevalence of MNDs was 14.1%. Differences in prevalence of MNDs across types of physical illnesses were small in magnitude (h=-0.02 to 0.35). CONCLUSION: Findings show that childhood physical-MND multimorbidity is common, highlighting the need for screening of MNDs among Canadian children with physical illness. Integrated care models are necessary to comprehensively address the physical and MND health needs of children. These estimates of morbidity snapshot the time immediately prior to the COVID-19 pandemic and have critical utility as baselines for future post-COVID-19 studies.

BACKGROUND: Multimorbidity is associated with physical-mental health comorbidity (PMHC). However, the scope of overlap between physical and mental conditions, associated factors, as well as types of mental illness involved are not well described in Eastern Europe. This study aims to assess the PMHC burden in the Estonian population. METHODS: In this population-based cross-sectional study we obtained health claims data for 55 chronic conditions from the Estonian Health Insurance Fund (EHIF) database, which captures data for all publicly insured individuals (n = 1 240 927 or 94.1% of the total population as of 31 December 2017). We assessed the period-prevalence (3 years) of chronic physical and mental health disorders, as well as associations between them, by age and sex. RESULTS: Half of the individuals (49.1% (95% CI 49.0-49.3)) had one or more chronic conditions. Mental health disorders (MHD) were present in 8.1% (8.1-8.2) of individuals, being higher among older age groups, women, and individuals with a higher number of physical conditions. PMHC was present in 6.2% (6.1-6.2) of the study population, and 13.1% (13.0-13.2) of the subjects with any chronic physical disorder also presented with at least one MHD. Dominating MHDs among PMHC patients were anxiety and depression. The prevalence of MHD was positively correlated with the number of physical disorders. We observed variation in the type of MHD as the number of physical comorbidities increased. The prevalence of anxiety, depression, and mental and behavioral disorders due to the misuse of alcohol and other psychoactive substances increased as physical comorbidities increased, but the prevalence of schizophrenia and dementia decreased with each additional physical disease. After adjusting for age and sex, this negative association changed the sign to a positive association in the case of dementia and mental and behavioral disorders due to psychoactive substance misuse. CONCLUSIONS: The burden of physical-mental comorbidity in the Estonian population is relatively high. Further research is required to identify clusters of overlapping physical and mental disorders as well as the interactions between these conditions. Public health interventions may include structural changes to health care delivery, such as an increased emphasis on integrated care models that reduce barriers to mental health care.