Transition from CAMHS to Adult Mental Health Services (TRACK): A Study of Service Organization, Policies, Process and User and Carer Perspectives

There is much concern about the transition of youth with mental health issues from child/adolescent to adult mental health services. This is complicated by their passage from childhood to adulthood which generates developmental needs beyond those that are illness-specific. Studies have shown that youth in this position lack continuity of care and transition support.

This UK study examined transitions from both a service practitioner or user perspective. Specifically, its objectives were to (a) identify factors that facilitate or impede effective transitions of clients with mental health problems from youth to adult services and the outcomes of that transition, and (b) make recommendations about the configuration and delivery of services that will promote good continuity of care. While the focus was on the provision of mental health services in the UK, the experiences and lessons learned can easily apply to the provision of employment services in Canada.

To meet their objectives, the researchers conducted an audit of transition policies and procedures in six UK health districts. They also reviewed 154 client cases who crossed the boundary from youth to adult services. As well, they conducted semi-structured interviews with a representative sample of professional staff working in youth and adult services, social services and voluntary organizations to explore factors that influence organizational boundaries, cultures, processes and resources affecting the transition of care. Also, they conducted in-depth interviews with a group of users who underwent the transition and with those practitioners who cared for them. The study was guided by a steering group of service users, carers, voluntary organizations, along with clinicians and academics.

Among the findings of this extensive study were the following. In their review of services, the researchers identified a variety of age-specific protocols. Some youth services take those aged 16-years or older who are in full time education, while many adult services set a minimum age of 18 for access to adult services, meaning those who are 16-18 years and not in full time education or employment are excluded by both services. However, none specified ways to prepare youth for the transition to adulthood and few had a provision for continuity of care.

From the review of and interviews with cases, it was found that very few of the youth under examination experienced an optimal transition — defined by at least one transition planning meeting, a period of joint working between youth and adult services, good information transfer, and being engaged in adult services for three months following transition. While youth with a severe and enduring mental illness, a hospital admission and on medication were most likely to make a transition to adult services, those with attention-deficit disorder, autistic spectrum disorder, emotional/neurotic disorder or emerging personality disorder were most likely to fall through the youth-adult services transition cracks.

From the interviews with staff, the researchers learned that perceptions of youth and adult services differed: the former were seen as more person-centred, holistic and family-oriented, whereas the latter were more medication- and crisis-oriented. Barriers to transition that were identified by the researchers included: variability in eligibility criteria and thresholds between adult and youth services, communication problems, lack of confidence among adult service staff on managing young people, lack of understanding and clarity about services, high staff caseloads, lengthy waiting lists, lack of in-patient facilities and limited services for neuro-developmental disorders.

Among the conclusions drawn by the researchers was that early and substantial service improvement is needed, much of which can occur by improved liaison, collaboration, and communication between youth and adult service providers. Dedicated but costly youth mental health services are needed to overcome barriers to youth-adult services transition.

This study would be of interest to practitioners encountering challenges in their provision of services to youth with mental health issues who are in the process of transitioning to adult care and services.