Mental health service transitions for young people

1. Fully involve the young person, family and carers where appropriate and with the young person's consent. Be transparent in planning and making decisions. Remember that mental health service transitions are a 'process', rather than simply a 'transfer'.

2. Begin planning as early as you can, and at least six months before the discharge from CAMHS, as well as managing realistic expectations for the input from adult services.

3. Refer young people to age-appropriate, accessible services where they exist; tell commissioners and providers where they don't exist. Do not assume that young people in CAMHS need transfer to AMHS. For example, some young people may not meet the criteria for severe and enduring mental illness, and thus may not be eligible for AMHS. Offer young people additional and alternative support to AMHS including support from non-health settings, voluntary sector services, primary health care (including GPs) and other universal services.

4. Take account of the wider context of young people's lives: there is a growing evidence base that helping young people with broader life issues leads to improvements in their mental health.

5. Work collaboratively with other professionals and agencies: staff should know how each other's services operate in order to provide co-ordinated and joined-up care.

6. Make service transition a flexible, managed process, with planning and assessments, continuity of care and follow-up. A period of shared or parallel care is good practice.

7. Work at the young person's pace and acknowledge that change takes time.

8. Follow up and monitor outcomes following the discharge from CAMHS, including those young people who don't transfer to AMHS.

9. Audit, review and evaluate your practice and service models, and include young people, families and carers in the process.

10. Use processes and corresponding paperwork that 'join up' and are consistent across agencies; formally agreed cross-sector transition protocols have many benefits.