Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study

• Published in: British journal of psychiatry 2010-10, Vol.197 (4), p.305-312
• Main Authors: Singh, Swaran P., Paul, Moli, Ford, Tamsin, Kramer, Tami, Weaver, Tim, McLaren, Susan, Hovish, Kimberly, Islam, Zoebia, Belling, Ruth, White, Sarah
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent Health Services - organization & administration; Adolescents; Adult; Age; Boundaries; Caregivers; Carers; Child; Child & adolescent mental health; Children; Children & youth; Cohort Studies; Continuity of care; Continuity of Patient Care - organization & administration; Continuity of Patient Care - standards; Drugs; Education; England; Female; Health problems; Health services; Health Services Research; Humans; Interprofessional Relations; Joint working; Male; Maternal child nursing; Medical Records; Medical referrals; Mental disorders; Mental Disorders - epidemiology; Mental Disorders - therapy; Mental health; Mental health care; Mental health services; Mental Health Services - organization & administration; National service; Neurodevelopmental disorders; Neurosis; Outcome and Process Assessment, Health Care; Personality disorders; Psychiatry; Qualitative Research; Referral and Consultation - organization & administration; Referrals; Teams; Trusts; Young adults
• ISSN: 0007-1250; 1472-1465
• DOI: 10.1192/bjp.bp.109.075135

Many adolescents with mental health problems experience transition of care from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). As part of the TRACK study we evaluated the process, outcomes and user and carer experience of transition from CAMHS to AMHS. We identified a cohort of service users crossing the CAMHS/AMHS boundary over 1 year across six mental health trusts in England. We tracked their journey to determine predictors of optimal transition and conducted qualitative interviews with a subsample of users, their carers and clinicians on how transition was experienced. Of 154 individuals who crossed the transition boundary in 1 year, 90 were actual referrals (i.e. they made a transition to AMHS), and 64 were potential referrals (i.e. were either not referred to AMHS or not accepted by AMHS). Individuals with a history of severe mental illness, being on medication or having been admitted were more likely to make a transition than those with neurodevelopmental disorders, emotional/neurotic disorders and emerging personality disorder. Optimal transition, defined as adequate transition planning, good information transfer across teams, joint working between teams and continuity of care following transition, was experienced by less than 5% of those who made a transition. Following transition, most service users stayed engaged with AMHS and reported improvement in their mental health. For the vast majority of service users, transition from CAMHS to AMHS is poorly planned, poorly executed and poorly experienced. The transition process accentuates pre-existing barriers between CAMHS and AMHS.