YoungMinds is campaigning to improve transitions care from child and adolescent mental health services to adult mental health services. We want to stop young people from getting lost in the system when they reach 16.
Young people who need help and support from mental health services can find themselves with no help and support at a time when they really need it. Through no fault of their own, when they reach 16 or 17 they can find themselves without any support because CAMHS (Child and Adolescent Mental Health Services) ends, and they are too young or not ill enough for AMHS (Adult Mental Health Services) which don’t start till they reach 18.
Different thresholds: To get any service from AMHS the threshold in terms of severity of illness is higher than CAMHS so many young people are locked out from receiving a service. For some, their illness has to reach crisis point before they receive a service from AMHS with the effect that their entry to services is more traumatic and more costly to the young person, family and to services than it would have been had their needs been met earlier.
Gaps in care: When young people are no longer eligible for CAMHS there is often a period of no support as they wait to access AMHS services and are put back on waiting lists. For some young people this can result in never making the transition.
Postcode lottery: The transition from CAMHS to AMHS is subject to extreme local variation, with some young people making the transfer to adult services at 16, some at 16 if not in school or 18 if in school, and some at 18, and many not transferring at all but disappearing into a void with long term consequences for their mental health and well being. A recent study of transitions in London found only 4% of young people reported a good transition, with many disappearing from services.
Communication: Poor communication between CAMHS and AMHS often leads to repeated assessments, new staff to deal with and new psychiatrists/psychologists to build relationships with. This means young people are often not getting the right help when they need it.
Negative perceptions: Differences between the service location and style of the two services alienates many young people who end up slipping off the radar of services. CAMHS and AMHS still report that they do not understand each other, with both perceiving the other in a negative light which affects the service’s abilities to work together to meet the needs of young people and families
"When people ask me about my experience with transition, my reply is usually along the lines of "what transition?". I didn't experience a transition. What I did experience was that it is very inconvenient to services that I didn't wait until I was 18 to get ill. If I had been offered the right help when I needed it, I might not have all of these scars."
What needs to happen?
- Young people need to receive a continuity of care with no delay in receiving services. There are already examples of services in England which combine the expertise of CAMHS and AMHS to work together to support young people and their families. Many Early Intervention Psychosis Teams have successfully combined CAMHS and AMHS, with both disciplines learning from each other. It's good some schemes are working, but we need a comprehensive approach to this issue.
- Whatever age is chosen to move young people into Adult Services, the transfer should be negotiated and supported to make sure that the young person does not leave services only to experience great difficulty in another aspect of their life and, for example, end up in the criminal justice system, or turn their back on services altogether.
- AMHS budgets need to shift to focus more on the 16-19 age group, this is an invest to save argument.
- The style of service needs to change within AMHS so it is more holistically focused, as in the CAMHS model
- Young people’s care plans need to involve a multi-agency approach
- Young people need to have a more central role in deciding their care plans.