Editorial Perspective: Using the levers to improve the mental health transitions of 15-25 year olds - learning from the evidence across the whole of health, social care and beyond.

Reflecting on the findings from the Scoping Review paper by Adu et al. (2022) and the insightful commentary from Emma and Toni Wakefield (2022) gave me the opportunity to ask all of us whether user, carer, practitioner, educator, researcher or policymaker, how can we together convert the growing evidence about best models of transitions into a reality? One that delivers across pathways of care and across geographies, with positive, sustainable and measurable whole systems change; both for Transitional Age Youth (TAY) with extant mental health problems and also a model that is able to sustain the population mental health and well-being of all 15-25 year olds. In this commentary, I discuss the essential framework needed to develop the system change discussed in these papers.

Manifesto for a healthy and health-creating society.

Brexit and the troubled state of the NHS call for re-thinking the UK's approach to health. The EU referendum vote reveals deep social divisions as well as presenting the country with important decisions and negotiations about the future. At the same time, health problems are growing; the NHS faces severe financial constraints and appears to lurch from crisis to crisis, with leaving the European Union likely to exacerbate many problems including staffing issues across the whole sector. However, new scientific developments and digital technology offer societies everywhere massive and unprecedented opportunities for improving health. It is vital for the country that the NHS is able to adopt these discoveries and see them translated into improved patient care and population health, but also that the UK benefits from its capabilities and strengths in these areas.

"What matters to someone who matters to me": using media campaigns with young people to prevent interpersonal violence and abuse.

BACKGROUND: While media campaigns are increasingly advocated as a strategy for preventing interpersonal violence and abuse, there is little evidence available regarding their effectiveness. SETTING AND DESIGN: Consultation with experts and young people was used as part of a UK scoping review to capture current thinking and practice on the use of media campaigns to address interpersonal violence and abuse among young people. Three focus groups and 16 interviews were undertaken with UK and international experts, and three focus groups were held with young people. MAIN RESULTS: Participants argued that, although campaigns initially needed to target whole populations of young people, subsequently, messages should be "granulated" for subgroups including young people already exposed to interpersonal violence and lesbian, gay, bisexual and transgender young people. It was suggested that boys, as the most likely perpetrators of interpersonal violence and abuse, should be the primary target for campaigns. Young people and experts emphasized that drama and narrative could be used to evoke an emotional response that assisted learning. Authenticity emerged as important for young people and could be achieved by delivering messages through familiar characters and relevant stories. Involving young people themselves in creating and delivering campaigns strengthened authenticity. CONCLUSIONS: Practice is developing rapidly, and robust research is required to identify the key conditions for effective campaigns in this field. The emotional impact of campaigns in this field appears to be as important as the transmission of learning.

Ending lethal discrimination against people with serious mental illness.

Each year in England 33 000 people diagnosed with a serious mental illness (SMI) die from causes that could have been avoided. Our mental-health-specific Atlas of Variation is the first to demonstrate the extent to which these inequalities and inequities affect mortality nationally.

Six years on: a prospective cohort study of male juvenile offenders in secure care.

Longitudinal studies are helpful in understanding developmental trajectories and recognising opportunities for early intervention. This paper describes the long-term needs and mental health of an initial sample of male juvenile offenders, now adults 6 years after their index admission to secure care. In this prospective cohort study of 97 male juvenile offenders admitted to secure, offenders were assessed initially on admission, 2 and 6 years later. Interviews were conducted with 54 offenders at the 6-year follow-up and included an assessment of psychosocial need, mental health and psychopathy. Outcome data on offending behaviour were collected on a total of 71 offenders. Persistent offenders have needs in multiple domains as they transition into adulthood. The majority of offenders were single and about a half were in neither employment nor training. Almost nine out of ten offenders had a substance misuse disorder and a similar number met the criteria for a diagnosis of antisocial personality disorder. Substance misuse in adolescence was strongly correlated with later substance misuse in adulthood, emphasising the importance of early intervention. A diagnosis of antisocial personality disorder and living with friends and family were both significantly associated with persistent offending behaviour. Many offenders continued to reoffend despite receiving offence-related interventions and custodial care. Interventions currently aimed at reducing recidivism in more severe offenders appear to be ineffective. Persistent offenders would benefit from a multi-modal approach based on individual needs, rather than receiving generic interventions.

Nursing knowledge in integrated care.

Nursing finds itself in evolving health and social care systems that will radically change the delivery of care and require new knowledge and ways of knowing. Integrated health and social care teams are becoming the norm. The traditional models of nurse knowledge and learning, based on medical models and the natural sciences, will not serve the needs of patients or nurses in this modernised framework of integrated care. This article examines the way in which nursing knowledge has been evaluated and offers suggestions for its continued development that are drawn from the experience of patients.

Using the lever of parity of esteem between mental and physical health to close the mental health gap - a call for action.

This paper provides a six-point definition of what parity of esteem for mental health means in practice. It highlights examples of the current disparity between mental and physical health and the importance of redressing this. The significance of securing a legislative basis for parity in England is discussed. The authors make a call for action, and pose six questions for international readers to consider and respond to.

A Study of Young Offenders' Perceptions of Health and Health Care Services in Custody and in the Community.

The level of unmet health needs in young offenders has been raised as a concern in recent research with this population. There is a lack of research examining the views of young offenders on health issues and the services available to them. This article summarizes a qualitative study conducted in four young offender institutions in the United Kingdom with young people expressing their attitudes toward aspects of health and the provision of health care services. While there were gaps in their knowledge, the young people were well informed of the services they could access. They also identified barriers to accessing these services and the effect that being in custody could have on their health. Many of the young people thought that the services provided in custody addressed their health needs more successfully than community-based services. Implications for user-informed service delivery to meet their health needs are discussed.

Fatal child maltreatment in England, 2005-2009.

OBJECTIVE: This paper presents comprehensive and up-to-date data covering 4 years of Serious Case Reviews into fatal child maltreatment in England. METHODS: Information on all notified cases of fatal maltreatment between April 2005 and March 2009 was examined to obtain case characteristics related to a systemic classification of 5 broad groups of maltreatment deaths (severe physical assaults; covert homicide/infanticide; overt homicide; extreme neglect/deprivational abuse; deaths related to but not directly caused by maltreatment). RESULTS: A total of 276 cases were recorded giving an incidence of 0.63 cases per 100,000 children (0-17) per year. 246 cases could be classified based on the data available. Of these the commonest specific group was those children who died as a result of severe physical assaults. Apparently deliberate overt and covert homicide was less common, while deaths as a direct consequence of neglect were rare. In contrast, some evidence of neglect was found in at least 40% of all cases, though not the direct cause of death. CONCLUSIONS: Class characteristics differ between the different categories of death and may suggest the need for different strategies for prevention.

Healthcare use by children fatally or seriously harmed by child maltreatment: analysis of a national case series 2005-2007.

AIM: To determine antecedent patterns of healthcare use by children fatally or seriously harmed by maltreatment. METHODS: The authors analysed recorded healthcare use for children who were the subject of a serious case review (SCR) in England in 2005-2007. The SCRs were initiated when a child under 18 years old died or was seriously harmed, maltreatment (abuse or neglect) was a factor, and there were lessons for interagency working. The authors analysed a purposive sample (N=40), similar in key demographics to all 189 SCRs in England in 2005-2007. RESULTS: Children had extensive recorded contact with universal (N=34/40; 85%) and secondary (N=26/40; 65%) healthcare services and children's social care (N=21/40; 53%). Thirty-one children (78%) had recorded health visitor and/or school nurse contact. Fourteen children (35%) had missed appointments. Almost three-quarters (N=29) had complex family problems recorded (parental domestic violence, alcohol/drug and/or mental health problems). Data quality regarding healthcare use was poor, and the extent and type of 'missing data' varied by age. CONCLUSIONS: Complex paediatric and family problems and a high level of contact with services preceded serious adverse events. Universal health services are likely to be well placed for giving ongoing and family-orientated support to vulnerable families. The absence of standardised data collection and any control group limits how far the Biennial Analyses of SCRs can meet their stated objective of identifying national trends and patterns. Linking SCRs to healthcare databases would provide a control group, improve understanding of the population context and diminish demands for data from professionals delivering care.