Implementation of evidence-based group interventions in a community-based mental health service for self-harming and suicidal youth

ABSTRACT

Objective

Suicide and self-harm have significant health, economic and social costs. Group-based interventions can be an effective and advantageous treatment approach; however, there is little evidence on the application of these groups in youth community mental health settings in Australia. Using the RE-AIM framework, we explore the feasibility and implementation of two group programmes in a youth-focussed community-based mental health service: dialectical behaviour therapy-adolescent (DBT-A) and cognitive behavioural Self and Strength (S&S).

Method

Data were collected from an Australian community mental health service that implemented two group therapy treatments over 12 months. RE-AIM implementation framework outcomes included programme reach (patient flow, group uptake, treatment completion), effectiveness (youth and care clinical outcomes), adoption (staff perception), implementation (barriers), and maintenance (service commitment and acceptability).

Results

Groups were considered for all eligible clients (61% of referrals), of these 36% accepted treatment and of those who commenced, 71% completed DBT-A and 82% completed S&S. DBT-A participants reported improved suicidality, emotion dysregulation, self-harm and quality of life (QoL). S&S participants reported improved QoL. Despite small sample size, treatment was acceptable to participants, with high retention and adherence across both groups. Clinicians involved in facilitation noted positive clinical impacts.

Conclusions

Group-based interventions have the potential to reduce emotion dysregulation difficulties for youth. Understanding barriers to uptake of group programmes in community-based mental health settings is essential to improve the reach and implementation of group programmes.

Key Points

What is already known about this topic:

1. Self-harm and suicide are major public health concerns for youth, with self-harm linked to suicide completion.

2. High rates of self-harm and emotion dysregulation occur in youth presenting to community-based mental health services. Clinicians need to be able to offer evidence-based interventions to support these individuals.

3. Group-based interventions for emotion dysregulation present an opportunity to improve health outcomes, facilitate skill development and encourage social help-seeking behaviour.

What this topic adds:

1. Group-based interventions for emotion dysregulation have positive clinical outcomes for young people who engage in these programmes and offer potentially cost-effective solutions to addressing youth mental health; however, reach was low.

2. Staff facilitators and group participants reported high acceptability and provided positive feedback on the group programmes.

3. Further investigation into the barriers for group therapy is required to develop and implement strategies to increase uptake of group therapy.

KEYWORDS:

• Community mental health
• youth mental health
• implementation
• self-harm
• suicide
• group therapy

Acknowledgments

We would like to acknowledge funding from the James and Diana Ramsay Foundation and Breakthrough Mental Health Research Foundation. We would also like to acknowledge the effort and support of the clinicians and leadership at Youth Mental Health Services, including Group Facilitators and Group Coordinators. Finally, we would like to acknowledge the clients and their families for taking part in this research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The deidentified data that support the findings of this study are available from the corresponding author upon reasonable request.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the James and Diana Ramsay Foundation and Breakthrough Mental Health Research Foundation.