Shared models of care for physical and sexual health concerns for young people with mental health difficulties: A scoping review

Background: Adolescence and early adulthood are periods for onset of mental health difficulties, often coinciding with emerging physical and sexual health needs. Fragmented care can leave young people underserved in these domains. Shared models of care (SMOC)- which integrate, mental, physical and/or sexual health services across primary and specialist settings – offer promise for more person-centred care. Yet little is known about how these models are implemented in practice or how well they address the full spectrum of health needs.

 

Our scoping review aims to 1) identify and characterise SMOC which integrate physical and/or sexual healthcare for young people with mental health difficulties, and 2) synthesise implementation barriers and enablers using the Implementation Science based Consolidated Framework for Implementation Research (CFIR), to guide future deployment in integrated settings.

 

Approach: This work is the first stage of a broader mixed methods programme seeking to operationalise the shared care recommendation from Ireland’s national mental health policy, Sharing the Vision, using implementation science and active patient and public involvement (PPI). We galvanised PPI from conception to dissemination: PPI partners helped refine eligibility criteria, interpret findings, and shape knowledge translation strategies. The scoping review was informed by JBI methods and reporting using the PRISMA-ScR reporting guidelines.

 

Five electronic databases and grey literature sites were searched in October 2024. Studies were eligible for inclusion if they focused on young people (aged 10–25) with mental health difficulties and described SMOC addressing mental health as a primary or equal concern to physical and/or sexual health concern. SMOC had to collaborate across primary and secondary mental health care to be eligible, with quality improvement studies within primary care settings excluded. Screening was conducted in duplicate, while data extraction and quality appraisals using the mixed methods appraisal tool (MMAT) were completed by one reviewer and verified by a second. Findings were synthesis thematically and mapped them to CFIR’s five domains.

Results: After screening 3223 citations and 20 grey literature sources, 25 SMOC were identified (meeting 60-100% of MMAT criteria). Most models (n=23/25) integrated care across mental and physical health, while nine integrated mental and sexual health and seven models integrated mental, physical and sexual healthcare needs. Models commonly included referrals into care, assessments, treatments, and links to external supports components.

 

Barriers frequently mapped to the inner and outer setting CFIR domains, including high staff turnover (n=9) and mental health stigma (n=7). Enablers included creating youth-centred models of care (e.g., trauma-informed, inclusive of culture and gender diversity; n=7) and communication across settings (n=5), aligning to CFIR process and innovation domains.

 

Conclusion: s: This review identifies that while integration of mental and physical health is reasonably widespread, sexual health remains under representation in SMOC frameworks. Implementation is persistently challenged by organisational and systematic barriers. As integrated systems advance globally, it is vital to ensure mental, physical and sexual health concerns receive equal consideration within integrated care settings, particularly during the transition from adolescence into young adulthood, to ensure integrated care models offer accessible, comprehensive care for young people with mental health difficulties