Mental and substance use disorders contribute the largest disease burden in young people [1, 2], with three-quarters first emerging between the ages of fifteen and twenty five . In Ireland, psychological morbidity has been reported in 21-27% of young adults , while the rate of youth suicide is the fourth highest of 26 European Union countries . Young people attend primary care regularly and as they often present with coexisting risk behaviour / psychosocial problems, primary care is ideally placed to address these issues opportunistically . However, healthcare professionals face many challenges when trying to identify youth mental and substance use disorders, including interpreting the developmental changes that coincide with adolescence as a mental disorder , fear of ‘over-medicalising’ young lives and misinterpreting depression as a normal response to the wider psychosocial context of a young person’s life .
Many health professionals, including GPs may not be entirely comfortable with identifying / treating young people with emotional mental / substance use disorders. Previous research found that an exploration of psychological issues does not always take place in GP consultations, even when the doctor feels that these are present and the adolescent is similarly aware [8, 9]. In the US, the median rate of recognition of youth mental health problems by GPs was only 18%, and was often initiated as a result of parental concerns . Findings from Fleury and colleagues (2012) suggested that GPs rarely used clinical screening tools or collaborated with other healthcare professionals, and tended to limit treatment options to monitoring medication or providing support therapy . Other studies have found that most primary care clinicians do not routinely screen for suicide risk [9, 12] and nearly 60% of youth in need of mental health services do not receive the care they need, even after suicide attempt .
Lack of time and training are often mentioned by healthcare professionals in primary care as major barriers to a comprehensive psychosocial diagnosis –. Other barriers included lack of financial reimbursement for uncompensated time spent on mental health screening , limited knowledge about suicide risk, poor availability of mental health services for referral , insufficient time to discuss mental health problems during consultations, restricted resources for screening (e.g. space, computers and staff) , patient confidentiality issues , lack of clearly defined guidelines, ineffective communication skills and reluctance to discuss sensitive issues  and in some cases healthcare professionals own stigmatising attitudes towards mental illness . Additionally young people themselves may be reluctant to contact healthcare professionals, or even recognise them as a source of help when distressed .
The challenge of youth mental health for healthcare professionals is especially evident in socio-economically disadvantaged areas where risk factors for mental health problems are especially common –, in addition to associated adverse psychosocial outcomes, like homelessness and drug use –. This concentration of health and social problems creates a level of demand which places substantial and continuous pressures on healthcare professionals .
There is a dearth of evidence regarding the experiences of and attitudes towards screening and treatment of mental and substance use disorders among healthcare professionals and young people in the Irish healthcare system and to date no clinical guidelines in relation to screening and early intervention have been published. However a similar approach has been employed in the development of clinical guidelines to inform hepatitis C management among current or former injecting drug users [28
]. In order to create future interventions for this population, it is important to understand how current practice with youth mental health in urban deprived areas is experienced by those who work within it: This knowledge ensures interventions will be tailored to the context and will address the relevant domains for improved services and outcomes. Since 2011, our study group has been working towards developing an intervention which addresses barriers to ‘early intervention’ for mental and substance use disorders that is evidence based, feasible and acceptable to young people and healthcare professionals. This work includes three phases:
Phase 1: will describe the experience of (and attitudes towards) screening and early intervention for mental / substance use disorders by interviewing a purposive sample of young people / healthcare professionals recruited from community agencies and primary / secondary care.
Phase 2: will develop a ‘complex intervention’ to improve screening and early intervention that is informed by the findings of phase 1, scientific evidence and a Delphi-facilitated expert consensus process.
Phase 3: will provide iterative feedback to participating healthcare professionals in the study from phase 1, 2 and determine what if any care components have been incorporated and any barriers encountered.
The current paper is based on findings from the first phase of the study, where one of the key aims was to describe healthcare professionals’ experience of (and attitudes towards) screening and early intervention for mental and substance use disorders among young people in primary care in deprived urban settings. Definitions of youth in the current study are in line with previous work on youth mental health where the terms ‘youth’ or ‘young people’ are often used to describe people within the 12 to 25 age range [6, 30].