Abstract
Young people moving from child and adolescent secure hospitals present with complex needs and vulnerabilities and are more likely to experience poor transition outcomes. Previous research has indicated the presence of several risk factors in periods of transition, such as poor liaison among services, lack of proper planning, shortage of beds in adult services, multiple transitions and lack of emotional readiness. However, little evidence exists about the processes and outcomes of transitions from adolescent secure services to adult settings. This study aims to bridge the gap in the existing literature by exploring the views and experiences of key professionals involved in the transition process from six adolescent medium secure units to nine adult secure and community services in England. Thirty-four key workers from 15 child and adolescent (N = 21) and adult (N = 13) forensic hospitals were interviewed to provide information about potential barriers and facilitators to transitions. Face-to-face semi-structured interviews were conducted between January 2016 and December 2017. Thematic analysis was used to identify challenges and facilitators to transitions. Three primary themes were identified: (1) transition processes and preparation; (2) transition barriers and challenges; (3) success factors to transition. Key differences in adult and adolescent service care-models and lack of emotional and developmental readiness to moving onto adult-oriented settings constitute major barriers to positive transition outcomes. Practice and policy implications are considered to address the need for service transformations.
Highlights
Transitions across mental health services in the UK are considered problematic due to a number of organisational and infrastructural challenges, such as transition delays, lack of bed availability and poor liaison between child and adult mental health services (Singh et al 2010)
Transition processes and preparation was a primary theme identified in the interview data with key professionals involved in young people’s transitions from adolescent secure services to adult services
Follow-up studies with young people at different times post-discharge would help to understand and reflect on their experiences. This was the first national study focussing on the experiences of mental healthcare professionals involved in transitions from adolescent forensic hospitals to adult mental health services and community settings
Summary
Transitions across mental health services in the UK are considered problematic due to a number of organisational and infrastructural challenges, such as transition delays, lack of bed availability and poor liaison between child and adult mental health services (Singh et al 2010). There is substantial evidence that transitions from paediatric services to adult care are linked to an exacerbation of medical and mental health symptoms (Campbell et al 2014). Previous research has classified transitions as a global priority for chronic conditions, including mental health (Campbell et al 2014). There has been an urge in recent years for mental health services to aim for a ‘better’ interaction with the legal framework (Hales et al 2019). Over the past two decades, transition of care from child and adolescent mental health services (CAMHS) to adultcentred settings has received global attention. Adolescence comprises a high-risk period for the emergence of mental
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