Abstract
Recent evidence confirms the risks of discontinuity of care when young people make a transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS), although robust data are still sparse. We aimed to identify when and how patients get lost to care during transition by tracking care pathways and identifying factors which influence dropping out of care during transition. This is a retrospective observational study of 760 patients who reached the transition age boundary within 12 months before transition time and being treated at CAMHS for at least during preceding 18 months. Data were collected at two time points: last visit to CAHMS and first visit to AHMS. Socio-demographic, clinical and service utilization variables on CAMHS treatment were collected. In the 12 months leading up to the transition boundary, 46.8% of subjects (n = 356) withdrew from CAHMS without further contact with AHMS, 9.3% withdrew from CAHMS but were referred to AHMS by other services, 29% were transferred from CAHMS to AHMS, 10% remained at CAHMS and 5% patients were transferred to alternative services. Fifty-six percent of subjects experience cessation of care before the transition age. The risk of dropout increases with shorter contact time in CAMHS, is greater in subjects without pharmacological treatment, and decreases in subjects with psychosis, bipolar disorder, eating disorders, mental retardation, and neurodevelopmental disorders. This study confirms that a large number of people drop out of care as they approach the CAMHS transition and experience discontinuity of care during this critical period.
Highlights
The importance of prioritizing adolescent mental health care is supported by the fact that most mental disorders appear before the age of 25 [1] and their contribution to the years lived with disabilities is 25% between 0 and 24 years of age [2]
child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) are at the “specialized and hospitalcare level”. Both services usually belong to the same department of psychiatry and mental health, so that patients seen at CAHMS can be referred to AHMS directly, without the need for a previous step through primary care
This is the first study that demonstrates the existence of a serious risk of interruption of care before the transition between a CAMHS and AHMS, showing that the problems associated with the transition phenomenon should be considered within a period longer than the one corresponding to the precise moment of the transition between services
Summary
The importance of prioritizing adolescent mental health care is supported by the fact that most mental disorders appear before the age of 25 [1] and their contribution to the years lived with disabilities is 25% between 0 and 24 years of age [2]. Services often do not meet the mental health needs of adolescents [3], with transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) being an important contributor to this unmet need when they reach the age of transition between both [4, 5]. The phenomenon of the transition between CAMHS and AMHS has been an increasing reason for study in recent. The available data suggest that patients at higher risk of being lost during the transition process are those with apparently less serious disorders, while subjects with psychotic, bipolar, eating, or neurodevelopmental disorders are more likely to make an effective transition [6] and to have a more adequate care pathway in terms of access to mental health services [9]
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