Mental health service transitions for young people
Practice example: Participation of young people in service design: Wakefield
To minimise risk to self and others, particularly frequency of self harm. For some young women, simply the knowledge that there will be continuity until transfer is formalised will be containing.
A comprehensive multidisciplinary transition service for 17 year old women at the Rivendell Unit is in its early stages (since Dec 2010). This designated unit is within a large (adult) female prison (HMP Newhall) for very vulnerable young women with high rates of self harm and complex psychopathology often resulting from multiple traumatic experiences in the past. The young people are transferred on their 18th birthday to the main prison site, with one or two transfers each month.
The transition service involves clear transition arrangements, formalised in a protocol joint between the Unit and the adult mental health provider in the main prison. A protocol in itself is only a first important step, and its implementation needs the participation of all parties involved. They plan to audit the implementation and success of the protocol.
There were previously been no formal transition protocols in place and it was possible for the young women to wait for a few weeks until they are picked up by the adult forensic team. Continuity of care rested on goodwill and was not formalised. The transition service was introduced at the same time as mental health input to the Rivendell Unit was transferred from the single adult forensic consultant to the newly established multidisciplinary forensic CAMHS team.
The young women were involved early on in the design of the new service through a focus group. They said that getting advice during transition was a key need. They emphasised the importance of having someone to talk to, of health professionals gaining their trust and maintaining confidentiality, and having practical support such as filling out forms. Formal feedback on the service will be collected from the young people who were transferred.
The main improvement is that the protocol facilitates communication between the young person, the Forensic CAMHS team and the Adult Mental Health Team from early on and well before the actual transfer is due. This reduces the anxieties of the young person and of the system.