difficulties moving from children's to adult mental health services

Below is advice on what to do if your child is due to move from children's to adult mental health services, and the right things do not seem to be happening.

No-one has offered an assessment, or talked about making a discharge plan. How can we get one?

Your young person’s Child and Adolescent Mental Health Services (CAHMS) team is responsible for making sure their move to adult services, known as transition, is properly planned and that he or she has a care plan in place before leaving CAMHS.

If no action has been taken to do this, you or the young person can tell their CAMHS keyworker or social worker that your child needs to be assessed and have a plan for his or her future care.

It might be helpful if you and your child put the request for an assessment in writing.

You could include the following points:

If under 18 your child should state that he or she may be a child in need and is requesting an assessment under section 17 of the Children Act. (If a young person is under 18 and receiving care from CAMHS they are likely to be a child in need under the act. Local councils must take reasonable steps to assess the needs of that child.) If the young person is nearly too old for CAMHS but does not know what help he or she will be getting when they are meant to leave CAMHS (ie on their next birthday), they can ask to be assessed under section 17
If your young person is assessed under section 17, you should also be included, on the basis that you are involved in the young person’s care. You can also request a carer’s assessment if you are providing a substantial amount of care on a regular basis.
If your child is over 18 or just about to turn 18 they should state he or she is requesting a community care assessment under section 47 of the NHS and Community Care Act. Section 47 says that anyone over 18 who may be ‘in need of community care services’ has the right to be assessed. Community care services include mental health services such as counselling and therapy, and also support from social workers.

What if the care plan doesn't offer the help needed?

If either you or your child disagree with the decisions that have been made, or with what is in the care plan, this should be discussed with their keyworker (or someone else at CAMHS) as soon as possible.

It can help to write down what you don't agree with and say what you think needs to be changed. In some cases you may be told that the changes you want cannot be made.

It’s really important to know that although young people going through transition should have their needs assessed, they do not have the right to get services to meet those needs. If your young person is told that he or she is not going to get help, the reasons for this decision should be explained by the keyworker when they go through the care plan.

One reason why your young person might be told that he or she is not going to get help from a particular service, for example adult mental health services, might be that the young person’s needs do not meet the eligibility criteria for adult mental health services.

For example, some mental health services will only accept a referral if a person has been diagnosed with a severe and enduring mental illness, is at risk of harming themselves, or has spent a lot of time as an inpatient in the past. Other services may not help if a person is taking drugs or using alcohol. This applies to AMHS and also health and social care services, and eligibility criteria are not the same in every area or for every service. It should always be explained to a young person why he or she does not meet the eligibility criteria for a particular service.

Ask for the eligibility criteria to be explained if it is not clear what they are, or why a service is not able to offer help to your young person.

There might be services which are not part of the NHS or local authority services which can help your the young person such as local youth counselling, advice and information centres run by charities and others. Keyworkers might know if this type of service is available in your area, or you can search online.

How can advocacy services help?

Advocacy services can help both young people receiving mental health treatment, and their carers.

Advocates work with young people to help them:

Get the information they need
Understand their rights
Say what they think so that others listen
Take part in decisions about their care and treatment
Understand what choices they have and make informed decisions
Know how to make a complaint if they need to.

Advocates can meet with young people, talk to them on the phone, come to meetings if they need support, and help write letters about their care. Many CAMHS services have links with advocacy services so it is worth asking if yours does.

There are two main circumstances under which people receiving mental health care have the legal right to an advocate:

If they are detained under some sections of the Mental Health Act
If they are receiving supervised community treatment.

In these cases young people have the right to get help from an independent mental health advocate, who can advise about their rights under the Mental Health Act.

Many local authorities have advocacy services for carers, to help them get a better service for themselves or those they are caring for. Check your local authority website for details, or ask the local social services department for help.

Complaints

If you are not happy about the treatment being given to your young person, or the way their transition to adult mental health services is going, you can complain. You can either do this on your own behalf as a carer, or by helping the young person. You can complain:

Informally – talk to someone in the team and let them know your concerns. If you have permission from your child, you can speak to their keyworker or care co-ordinator. If they are part of the problem you can ask to talk to their manager or someone else in the team
Formally - you can use the official complaints procedure for the service. (Information about this should be given when the young person starts using the service.) You may have to fill in a form or write the complaint down. You can only do this on behalf of a young person if they give you written permission to do this, but you can complain on your own behalf as a carer.
You or the young person could also ask for help from an advocate.

It is best to try and sort the complaint out as soon as you can. Think about:

What you are unhappy about
When it happened (or, if it is a long-term thing, when it started)
Who is involved
The impact it has
What you would like to change.

If you are complaining informally, the person you complain to should tell you what they are going to do about the complaint. If they do not do anything you should use the official complaints procedure.

If you are using the official complaints procedure, there will be a process to follow. This will include times by when people should respond to your complaint, try and address it, and inform you what they have done. If these are not followed you have the right to insist that they are.

If you or the young person you support are not happy with the response that you get to your complaint, you can complain to an ombudsman, someone who investigates complaints about public services. If the complaint is about the young person’s social care then you can complain to the local government ombudsman. If it is about your young person’s health care, then you can complain to the health service ombudsman.

In some cases your child may need to get some legal advice. For example, if they have asked to have an assessment and are told they are not going to get one, or have been waiting a long time for an assessment, or has had an assessment and is told they are not going to get any help but not told why, it is important to get advice on what to do next.

If you think that your child might need this sort of help ask to speak to an advocate.

You can also contact Mind’s Legal Advice Line, or the Children’s Legal Centre for advice.

What if the young person is an inpatient at the time of transition?

Children and young people who are in hospital when they turn 18 or get too old for the unit they are in, may move to a unit for adults or older young people, or may be discharged if they are well enough to leave hospital.

In either case, their needs must be assessed before they move to another hospital or inpatient unit or get discharged.

If the young person is moving to another inpatient unit for older young people or for adults, their care co-ordinator must make sure the next place they go is suitable for their needs. If they are under 18, you might hear the words age appropriate in the discussions on where the young person is to be moved to when they leave the CAMHS unit. This is because if the young person is under 18, they must be placed on ward which is suitable for someone of their age, depending on what their needs are when they are admitted.

This usually means a unit for under 18 year olds, but in certain circumstances they might be admitted to an adult ward either because it meets their needs in a way the under 18 units can’t, or because of an emergency. If the young person is on an adult ward and is under 18, staff have to make sure they are safe, and if they have been admitted because of an emergency staff must make sure they are moved to a CAMHS unit very quickly.

For information about young people's rights when they are an inpatient, and how to make sure they get the best care, they can use the Headspace toolkit.

If your child is moving to adult inpatient services, it is very important to prepare for the change because adult wards can be very different to CAMHS inpatient units. Visiting hours may be shorter and the patients they are treated alongside might have different types of problems. This can be hard to get used to and you may have to be very clear with staff about the support you think the young person needs when they first move.

If your child is well enough to leave hospital, they must have a care plan for the future.

Your child may have additional rights if detained under the Mental Health Act. If they were admitted to hospital under section 3 (known as admission for treatment) they must be assessed under section 117 of the Mental Health Act 1983 before they leave hospital. A young person admitted to for treatment following an order of a court, for example, a hospital order under section 37 of the Mental Health Act 1983 should also be assessed under section 117.

If section 117 of the Mental Health Act 1983 applies, young people have the right to receive after-care services on leaving hospital. This will require an assessment of needs. In addition to any ongoing needs for mental health care, a range of issues should be considered, including the young person’s physical health, housing needs, daytime activities or employment and assistance in welfare rights and managing their finances. A care plan that sets out how these needs are to be met should be prepared before the young person leaves hospital

"My daughter was discharged from a CAMHS unit but they did not communicate with the AMHS services outside at all. We had to really fight to get her into AMHS and we had to give them all the information about her case all over again. I would tell any parent, ask staff to make sure you and your child know who is going to support them before they leave the unit. They should meet them when they are still an inpatient otherwise it can cause a lot of anxiety."

Asylum seekers and refugees

If you are supporting an asylum seeker or refugee, it is important to know they are entitled to free NHS care, including mental health services, unless their asylum claim has failed. This means the young person has the same rights at transition as other young people.

If their asylum claim has failed, they may still get free NHS primary care if a GP or other doctor chooses to give it to them (it is at the doctor’s discretion). But they may be charged for specialist or hospital care unless it is emergency treatment (A&E) or compulsory mental health treatment (which is given when they are detained under the Mental Health Act 1983 or receiving supervised community treatment).

Asylum seekers can unfortunately find harder to get their mental health needs met, as things like language differences, moving areas or lack of cultural understanding on the part of professionals can get in the way. However the professionals involved in your young person’s care should try to help him/her with such difficulties, for example make sure that an interpreter is available at all the meetings about the young person’s future care so that the young person can make his/her views known.

Also if a young person was admitted to the UK as a child refugee, they may have their claim re-examined when they reach 17, which can complicate the process of transition as it may delay decisions around what care they are eligible to receive.

If the young person you are supporting is in this situation, talk to their case worker if they have one, or ask CAMHS to help them find an advocate.