Mind the Gap Between CAMHS and AMHS: The Perspectives Of Patients with Anorexia Nervosa, Parents and Professionals

• Main Author: Lockertsen, Veronica
• Format: Dissertation
• Language: English

The transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) often represents a difficult period for patients with anorexia nervosa and their parents. They become disconnected from CAMHS and often have start-up challenges in AMHS. Together with former service users, we conducted a qualitative study to explore experiences with the CAMHS-AMHS transition from three different perspectives, represented in each article included in this dissertation. In this dissertation, we discuss three main themes collectively representing the different perspectives. We anchored our theoretical understanding of transitions in Melisis` Transition theory. First, the fact that unprepared transitions have systemic explanations and contribute to personal and health-related consequences. Overall, the transition from CAMHS to AMHS is experienced as unprepared, without consideration of the patient’s individual needs during the transition period. Being unprepared complicates the patients and parents’ disconnection from CAMHS and makes the startup in AMHS difficult. Preparing the transition, should create a better chance of a successful transition. Preparations should explicitly describe the differences between services for both parents and patients. Good collaboration is essential in achieving continuity in treatment and closing the gap between the services. However, managing this collaboration is experienced as challenging due to systematic barriers. Second, different treatment cultures between the services—implying a difference in attitudes toward patients’ autonomy and parents' role in treatment—negatively affect treatment and recovery. These manifested differences made it challenging to consider the individual patients’ level of maturity and ability to be self-sufficient. With AMHS routinely not involving parents, they felt excluded from their adolescents’ treatment. As they are often responsible for providing meal support and serving as their adolescents’ care providers in this period, the lack of involvement was constraining and created stress for parents. The transition period was perceived as a very uncertain time, with negative consequences for both patients’ health and parents’ wellbeing. Third, knowledge is one of the most important factors in the transition. From the patient’s perspective, professional competence was vital for developing trust and feeling safe with the new professional in AMHS. From the professional’s perspe