Abstract
BackgroundPoor transitions to adult care from child and adolescent mental health services may increase the risk of disengagement and long-term negative outcomes. However, studies of transitions in mental health care are commonly difficult to administer and little is known about the determinants of successful transition. The persistence of health inequalities related to access, care, and outcome is now well accepted including the inverse care law which suggests that those most in need of services may be the least likely to obtain them. We sought to examine the pathways and determinants of transition, including the role of social class.MethodA retrospective systematic examination of electronic records and case notes of young people eligible to transition to adult care over a 4-year period across five Health and Social Care NHS Trusts in Northern Ireland.ResultsWe identified 373 service users eligible for transition. While a high proportion of eligible patients made the transition to adult services, very few received an optimal transition process and many dropped out of services or subsequently disengaged. Clinical factors, rather than social class, appear to be more influential in the transition pathway. However, those not in employment, education or training (NEET) were more likely (OR 3.04: 95% CI 1.34, 6.91) to have been referred to Adult Mental Health Services (AMHS), as were those with a risk assessment or diagnosis (OR 4.89: 2.45, 9.80 and OR 3.36: 1.78, 6.34), respectively.ConclusionsDespite the importance of a smoother transition to adult services, surprisingly, few patients experience this. There is a need for stronger standardised policies and guidelines to ensure optimal transitional care to AMHS. The barriers between different arms of psychiatry appear to persist. Joint working and shared arrangements between child and adolescent and adult mental health services should be fostered.
Highlights
The transition from Children and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is a major concern for many young service users (SU) and their parents/carers
We identified the following service user types: (1) those at the appropriate age for transition, considered for transfer and expected to have on-going needs; (2) those being seen by CAMHS because of the lack of an adequate/appropriate adult service; and (3) those discharged or disengaged from CAMHS with a continuing mental health problem
We examined the data for differences in the relationship between those remaining in adult services and those who left for some reason
Summary
The transition from Children and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is a major concern for many young service users (SU) and their parents/carers. Poor transitions to adult care from child and adolescent mental health services may increase the risk of disengagement and long-term negative outcomes. Method A retrospective systematic examination of electronic records and case notes of young people eligible to transition to adult care over a 4-year period across five Health and Social Care NHS Trusts in Northern Ireland. Rather than social class, appear to be more influential in the transition pathway Those not in employment, education or training (NEET) were more likely (OR 3.04: 95% CI 1.34, 6.91) to have been referred to Adult Mental Health Services (AMHS), as were those with a risk assessment or diagnosis (OR 4.89: 2.45, 9.80 and OR 3.36: 1.78, 6.34), respectively. Joint working and shared arrangements between child and adolescent and adult mental health services should be fostered
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