Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study.
BACKGROUND
Many adolescents with mental health problems experience transition of care from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS).


OBJECTIVE
As part of the TRACK study we evaluated the process, outcomes and user and carer experience of transition from CAMHS to AMHS.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Singh
Swaran P
SP
Health Services Research Institute, Medical School Building, Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK. S.P.Singh@warwick.ac.uk
Paul
Moli
M
Ford
Tamsin
T
Kramer
Tami
T
Weaver
Tim
T
McLaren
Susan
S
Hovish
Kimberly
K
Islam
Zoebia
Z
Belling
Ruth
R
White
Sarah
S
D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration; D000328:Adult; D002648:Child; D015331:Cohort Studies; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D004739:England; D005260:Female; D006302:Health Services Research; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008499:Medical Records; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D036301:Qualitative Research; D012017:Referral and Consultation / Q000458:organization & administration