The Jigsaw Journey: Investigating a Brief Intervention Model of Mental Health Support for Young People

The aim of this thesis was to contribute to our understanding of young people’s journey of engaging with brief intervention support provided by integrated youth mental health services by (1) investigating risk factors for psychological distress among help-seeking young people, (2) exploring lived experiences of young people engaging with brief intervention support, (3) developing a model of therapeutic change for this context, and (4) testing for longitudinal outcomes and factors associated with outcomes among young people engaging with this form of support. Three studies were conducted with Jigsaw, the National Centre for Youth Mental Health in Ireland. Study 1 used a quantitative design, analysing routinely collected data from young people engaging with Jigsaw (N = 9,673) to identify risk factors for psychological distress. Analyses revealed psychological, behavioural, and contextual risk factors were strongly associated with young people’s self-identified experiences of depression, and self-harm and suicidality. However, regression analyses indicated factors were poor predictors of psychological distress as measured by the CORE. The findings provide insight into the factors that are associated with young people’s self-identified distress which can inform clinical practice in this context. Study 2 adopted a qualitative design to explore young people’s experiences of the brief intervention support journey. Interviews were conducted with young people (N = 11) and clinical staff (N = 9). The perspectives of young people complemented the views of clinical staff, with both acknowledging the uncertainties surrounding help-seeking, the safety provided by a non-judgemental therapeutic relationship, the non-directive input from the clinicians, and the bittersweet feelings associated with completing the intervention. Young people pointed to opening up emotionally as an important change they experienced through the intervention and clinicians attributed change to young people adopting a strengths-focused narrative. These findings informed the development of the adapted Contextual Model, a model proposing each of the therapeutic relationship, emotional awareness and expression, and self-efficacy as pathways to better outcomes for young people. Study 3 used a quantitative design involving routine outcome measurement and online surveys to test longitudinal outcomes and factors associated with youth outcomes (N = 98 at baseline, falling to N = 29 at follow-up). There was evidence of young people aged 17-25 maintaining reductions in distress three months after completing the intervention and mixed evidence to support associations between therapeutic alliance, emotional awareness and expression, and outcomes. Recruitment and retention difficulties in the study were investigated. Key factors to consider in future research include the following: communicating the goals of the study, gatekeeping, incentivising young people to participate, and integrating research into services. Overall findings across the three studies provide insights into the factors affecting young people on their journey of engaging with brief intervention support. Findings are discussed in relation to theoretical, policy, and practical implications for clinical practice and research with integrated youth mental health services.