How important are thinking skills to young people with mental Illness?

Mental health services have had a long and inglorious history of guessing service users’ wished treatment outcomes. Luckily in recent years, service users’ opinions have started to shape more and more clinical priorities and access to interventions. Nonetheless there are outcomes where divergence between service users’ and clinical services’ priorities still exist.

Thinking skills or cognitive wellbeing are prime examples where this divergence is evident. But how big is the gap?

A recent paper by Bryce et al., published in Early Intervention in Psychiatry provides an answer from the point of view of young people with mental health problems.

The study considered data from a national survey run in Australia called “Your Mind, Your Choice” active between December 2020 and August 2022. People between 12 and 25 years of age and who received mental health support were included. Participants were asked to complete an online survey asking to rate the importance of 20 recovery and well-being outcomes, including cognition, when receiving mental health treatment. They were also asked to share their experiences of cognitive difficulties and what they wanted treatments to address and to rate their likelihood of trying 14 different treatments for cognition including behavioural, pharmacological, and physical therapies.

243 participants completed the survey, with the majority self-disclosing problems with depression, anxiety, and PTSD. Psychosis and bipolar disorder were disclosed by over 10%. Out of the 20 outcomes considered cognition was ranked 6th after outcomes including mental health, emotions, stress, relationships, and sleep.

When asked how important it would be for treatment to focus on addressing cognitive difficulties participants rated this 76.3 out of 100 with importance considerably higher in those who reported cognitive difficulties.

Preferences for cognitive treatment included compensatory training (i.e., teaching strategies to improve cognitive skills like memory and attention), sleep interventions, psychoeducation, cognitive strengths-based treatment (i.e., emphasising and optimising the use of existing cognitive skills), and exercise. However, there was a high variability in their preferences.

These results indicate that addressing cognitive difficulties is a priority for young people. Cognitive health was rated at the same level as relationships and academic functioning. Most respondents (70%) endorsed cognitive concerns, but only a third had received treatment for their cognitive difficulties confirming a treatment gap in this area.

The variability in treatment preferences highlighted in the study underscore the need for clinicians and clinical services to work together with service users to identify outcomes that matter to them and the most suitable treatments.

Study reference: Bryce S, Cheng N, Dalton A, Ojinnaka A, Stainton A, Zbukvic I, Ratheesh A, O'Halloran C, Uren J, Gates J, Daglas-Georgiou R, Wood SJ, Allott K. Cognitive health treatment priorities and preferences among young people with mental illness: The your mind, your choice survey. Early Interv Psychiatry. 2023 May 17. doi: 10.1111/eip.13436.

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