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How social context impacts on the development, identification and treatment of mental and substance use disorders among young people – a qualitative study of health care workers

Published online by Cambridge University Press:  13 January 2015

D. Leahy ,
E. Schaffalitzky ,
C. Armstrong ,
L. Latham ,
F. McNicholas ,
D. Meagher ,
Y. Nathan ,
R. O’Connor ,
V. O’Keane  and
P. Ryan
...Show all authors
D. Leahy
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland
E. Schaffalitzky
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland
C. Armstrong
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland
L. Latham
Affiliation:
Thomas Court Primary Care Centre, Dublin, Ireland
F. McNicholas
Affiliation:
UCD School of Medicine & Medical Science, Dublin, Ireland
D. Meagher
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland
Y. Nathan
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland
R. O’Connor
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland
V. O’Keane
Affiliation:
Trinity Centre for Health Sciences, Tallaght Hospital, Dublin, Ireland
P. Ryan
Affiliation:
Department of Psychology, University of Limerick, Limerick, Ireland
B. P. Smyth
Affiliation:
Department of Public Health & Primary Care, Trinity College, Dublin, Ireland
D. Swan
Affiliation:
Graduate Entry Medical School, University of Limerick, Limerick, Ireland
W. Cullen*
Affiliation:
UCD School of Medicine & Medical Science, Dublin, Ireland
*
*Address for correspondence: Professor W. Cullen, UCD School of Medicine & Medical Science, Belfield, Dublin 4, Ireland. (Email: Walter.Cullen@ucd.ie)
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Abstract

Introduction

Social context has a major influence on the detection and treatment of youth mental and substance use disorders in socioeconomically disadvantaged urban areas, particularly where gang culture, community violence, normalisation of drug use and repetitive maladaptive family structures prevail. This paper aims to examine how social context influences the development, identification and treatment of youth mental and substance use disorders in socioeconomically disadvantaged urban areas from the perspectives of health care workers.

Method

Semi-structured interviews were conducted with health care workers (n=37) from clinical settings including: primary care, secondary care and community agencies and analysed thematically using Bronfenbrenner’s Ecological Theory to guide analysis.

Results

Health care workers’ engagement with young people was influenced by the multilevel ecological systems within the individual’s social context which included: the young person’s immediate environment/‘microsystem’ (e.g., family relationships), personal relationships in the ‘mesosystem’ (e.g., peer and school relationships), external factors in the young person’s local area context/‘exosystem’ (e.g., drug culture and criminality) and wider societal aspects in the ‘macrosystem’ (e.g., mental health policy, health care inequalities and stigma).

Conclusions

In socioeconomically disadvantaged urban areas, social context, specifically the micro-, meso-, exo-, and macro-system impact both on the young person’s experience of mental health or substance use problems and services, which endeavour to address these problems. Interventions that effectively identify and treat these problems should reflect the additional challenges posed by such settings.

Keywords

Bronfenbrenner’s Ecological Theorygeneral practicemental health and substance useprimary health caresocial contextsocioeconomic disadvantageyoung people
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 32 , Issue 1: Special Issue: Youth Mental Health , March 2015 , pp. 117 - 128
Copyright
© College of Psychiatrists of Ireland 2015 

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