Transition Questions
At a certain age – it varies depending on where you live - young people getting help from Children and Adolescent Mental Health Services (CAMHS) must move onto Adult Mental Health Services (AMHS). This is called transition and is a big change.
Some CAMHS stop seeing young people after their 16th birthday. Others will support young people until they are 18, or when they leave school or college. You and your child should be told in good time, ideally six months before they will have to leave CAMHS.
To prepare for a young person’s transition from CAMHS to adult services, they should have an assessment of needs (sometimes called a discharge plan) and a care plan.
What is an assessment of needs for?
An assessment is to find out what support a young person might need on leaving CAMHS.
Young people may continue to need a lot of support from mental health services. If so, CAHMS and Adult Mental Health Services (AMHS) will meet with the young person to decide what will happen.
Parents should be included in these meetings if the young person would like you to be there.
Assessment is a chance for the young person to ask for help and for parents to have your say. It can be an opportunity for the young person to ask for more help and to say what helps them most.
The CAMHS team should help young people and parents prepare for moving to adult services. They should explain what help Adult Mental Health Services provide, and how they differ from CAMHS.
"As a parent, it's so important that CAMHS talk to you as well as your child about what adult services will be like. You are told they will be different but not how. My daughter and I found it a really anxious time as we didn't know what to expect."
It is possible that the AMHS team may decide young people are not eligible for help.
Families can feel they are leaving the safety of CAMHS and moving to the unknown. They wonder whether and how they will be included. My daughter's transition was stressful despite an early start by CAMHS, as initially we only heard from adult services by letter. It was a confusing and difficult time. But overall it was successful in that she did transfer to adult services and stay with them until she was well."
How does an assessment work?
A member of a young person’s CAMHS care team should make arrangements for his or her needs to be assessed. This is likely to be their keyworker or care co-ordinator. (if you are not sure who this is, just ask). The person appointed as lead professional (you should be told who this is) must make sure the right people are involved in a young person’s assessment and that the assessment takes place.
The lead professional should tell you, and the young person, about the assessment, including what will happen when. They should help the young person decide what is really important for them, and make sure their views are listened to and taken into account.
You might hear CAMHS staff talking about CAF (common assessment framework), or the assessment framework. These are systems for making sure all the right questions are asked at the assessment. You can ask CAMHS to explain more about this.
Young people should be asked at the assessment how they are feeling, if they think CAMHS treatment is helping, and how things are going at home and in other areas of their life, including education, health, housing, work, relationships and friendships. They should be asked what help they think will be needed with these things in the future. You as their parent or carer should also be asked about these different areas and what support you think they will need from adult services.
If your young person is involved with the youth justice system as well as being seen at CAMHS, their youth offending team should also be involved in the assessment.
The young person may also be having a separate assessment about continuing education or training, if they are registered as having special educational needs. Ask their teachers about this if you are not sure.
If the young person’s assessment shows they have additional health or housing needs, the professionals carrying out the assessment must refer their case to the organisation responsible for arranging such services. For example, if the young person does not have anywhere suitable to live, their case should be referred to the local housing authority as soon as possible. If the young person is under 18, children’s social care services should also be informed. The young person should be told who has been contacted and what action is being taken.
Being assessed at transition can also be an opportunity for the young person, or for you as a carer, to have more control over the help you receive, if you or the young person has been assessed as needing help from social services.
Direct payments are local council payments for people who would like to arrange and pay for their own care and support services instead of receiving them directly from the local council.
If your young person is aged 16 or 17, you might be able to receive direct payments on their behalf. If they are over 18, they could get the payments on their own behalf, while you can apply for support as a carer by having a carer’s assessment.
How can I be included once the young person I am supporting is using adult services?
You can still support your child when they move to adult services, if that is what your child wants. During the assessment your child will be asked about the support they receive from relatives and friends, what type of support they are getting and whether this is likely to continue.
If young people want another parent or carer to be involved, they must tell the services this, or it may be assumed they don’t want them involved. Young people should ask for this to be written in their care plan, so everyone is aware how involved the young person wants their parents and carers to be, and professionals should comply with the young person’s wishes. (The young person has the right to change their mind at any time.)
Many parents feel their children need them more than ever at this crucial point in time, and want to be involved as much as possible. Others may not feel able to help, for a variety of reasons. Equally some young people are very keen to have their parents or carers involved, while others feel they want their treatment and support to be private, or might not have anyone they trust enough to help them.
Will I get any help as a carer?
You may be able to get help so you can continue to support your young person. You will be a carer and have a right to a carer’s assessment if you provide a substantial amount of care on a regular basis. You will need to inform the young person’s care team that you are his or her carer and request an assessment of your needs as a carer.
The purpose of the carer’s assessment is to find out what help you need so you can continue to provide care.
In this assessment, you will be asked:
- How much time you spend looking after your young person
- What sort of help and support you provide
- What the effect is on you – this can include the impact on your health, your finances the amount of time you might need to take off work to care for the young person.
You may be offered practical support, or in some cases money to help look after the young person. You might already be getting support as a carer from when you were involved with CAMHS but will probably need to be assessed again as the young person becomes an adult.
"My son has obsessive-compulsive disorder and depression. When he moved to Adult Mental Health Services I asked for a carer's assessment because it was getting really hard to keep on top of things at home, as well as looking after him. It took a while but eventually I got direct payments which we put towards a cleaner, and this makes it much easier at home."
What happens after the young person’s assessment?
The professionals involved in assessing your young person’s mental health and other needs will then decide what, if any, support should be given to the young person to meet these assessed needs. They will decide whether your young person should be given a service to meet his or her needs, by using what are known as eligibility criteria.
Eligibility criteria are the levels of need a service says a person must have to get help from them. If they think the person’s needs are lower than that level, they will not offer them help. The purpose of eligibility criteria is to make sure that the people most in need get help. Eligibility criteria vary from area to area.
If the young person you are supporting is not given a service to meet his or her assessed needs, they should be told why not. For example, even if the young person has been assessed to have some mental health needs, he or she may not qualify for help from Adult Mental Health Services. This may be because AMHS have assessed that the young person does not need the high level of support and care that they provide. However the reasons why they think this should be explained to your young personAfter the assessment, the young person's keyworker should meet with the young person and explain:
• What the people who carried out the assessment understands the young person’s needs to be
• How the professionals are going to try to meet those needs.
If the young person agrees, you should be included this meeting, or the young person could ask a friend or an advocate to go with them instead.
Your young person should also get a written copy to keep for themselves, and if they agree, you or other parents or carers should also be sent a copy of the care plan. This might be called a discharge plan, or a care plan, but it should say clearly what support the young person will get in the future, and how to get help quickly if this is needed.
What is in a care plan?
The care plan should mention the following areas, and clearly state who will meet each need and what services will be provided to the young person:
• Mental health and emotional support: this will set out what help is to be provided by AMHS or another service. If such support is not provided, the plan should include advice on how the young person can keep well and healthy
• Who to contact in an emergency, or if things start to go wrong and more help is needed.
• Disabilities - what help they will get to manage any disabilities they have.
• Physical health – Any physical health problems which mean they need to see a doctor or nurse should be mentioned, and any help they will get with diet, exercise, sexual health or other things.
• Education – If they are in school or college or deciding whether to go back, what support they will receive to get there, or to do as well as they can?
• Employment and training – this part of the plan will state any support or help they will get with these.
• Housing – Any support they will get to find safe and supported housing which meets their needs.
• Supporters and carers – Who helps look after them (you and /or other people), and what they do. The help or support these carers need to do this
• Friends, positive activities and youth services - what makes them happy and how they can be supported to carry on with these things.
The young person must be asked what they think about their care plan, and if they agree or disagree with it. If your child agrees, you and/or other parents or carers should also be consulted. Once the young person has seen the plan they should ask for their GP to be sent a copy.
Do I have the right to know what is happening?
Everyone has the right to have their personal information, such as their diagnosis and treatment, kept confidential. This means that, even if your child is not 18 yet, he or she can decide whether they would like you to be informed about their care and treatment.
Except in very limited circumstances, those working in CAMHS and AMHS cannot give you information about your young person’s treatment and care without their permission. An example of when confidential information could be given to someone without the young person’s permission is if this is necessary to protect other people from serious harm or to prevent a serious crime.
If you think you need certain information so you can support your child (for example knowing what medication the young person has been prescribed and when he or she needs to take it), you should discuss this with your child. If they do not want you to have this information, you should discuss how this will affect your ability to care for your young person with their care team.
Parents and carers whose children are at CAMHS often have a high level of involvement with the service (for example, joint sessions with the children, regular reviews of progress, or separate meeting to advise on how to help at home).
You may find that, in comparison, adult services seem to communicate less with parents and carers. One reason for this might be the difference in approach between CAMHS and AMHS. In AMHS young people are seen more as individuals than part of a family. This can be difficult for parents and carers who were previously very involved with their child's care, and when the child moves to AMHS they can feel shut out.
However, if your young person has been happy for you to be involved with CAMHS, there is no reason for this to change when the young person moves to AMHS. Many older young people and adults still want their parents or carers involved in their care, to support them and help them to make the right decisions.
They might gradually make more of the decisions on their own as they get older.
If your young person moves to AMHS and wants you to continue to be involved in your care and treatment, he or she should make sure that their care team know this. If the young person doesn’t let them know, the care team may assume he or she doesn’t want parents or carers to be involved.
Your young person may want you to have some information about his or her care and treatment but for other details to be kept confidential, and should tell the care team:
• What information can be given to parents or carers
• What he or she would like to be kept confidential.
The young person should ask for this to be written into the care plan, so the care team know what information they can give to parents or other carers.
The young person can change their mind about who they would like to be informed about their care at any time.
What if my child needs a lot of help?
If your young person needs a lot of support with their mental health, the treatment and care that they receive should be provided under the care programme approach (CPA). This is a system within mental health services for making sure people who have serious or complex mental health needs get the support they need. It is mainly for adults, though some children and young people in CAMHS inpatient units might already be under it.
The care programe approach should also be used for people under 18:
• When they are being transferred from child to adult services
• When they come out of hospital.
Ask the CAMHS team about the care programme approach if it is not mentioned.
If your young person does get help under the CPA, a mental health professional will be chosen to be their care co-ordinator, they are responsible for making sure they get the help they need from different services.
Treatment and support should be reviewed at least every six months – to check how it is going and if anything needs to be changed. This is often called a CPA review, and all the relevant professionals should attend, as well as parents or carers if this is what the young person wants. The young person must be kept fully informed about their care, and their opinions must always be taken into account.
Even if your young person is not offered help under the CPA, he or she should still be given an assessment of their needs and a care plan.
"At first I had no idea what CPA meant and I had to ask for this to be explained. In fact the CPA meetings were a chance for everyone to get together and talk about my son's care. As he wanted me and his stepdad to be included, we could say what we thought and help him say what he wanted."