Mental health service transitions for young people
Service styles, models and barriers: Providing consistent professional support
In recent years, a number of different models for key workers or care co-ordinators have emerged, including, for example, transition workers, joint posts and secondments. Irrespective of the model and job title, young people want access to a consistent, designated lead professional they can get to know over a period of time and who will:
- plan and manage the service transition
- help them to access adult services
- give support for a period during the transfer.
The SCIE practice enquiry and research briefing highlighted the critical importance of lead professionals. When they are not there, which is more usual than might be expected, transition is often not well managed. It is also important to be explicit with the young person and the different agencies involved about who holds responsibility for the service transition.
One young person explained how important consistency and continuity is:
'She is the best person ever! She'd make you feel at ease and I could offload. I would see her for counselling every week for about 18 months. She went with me to meet the EI team and I carried on seeing her under the EI. She introduced me to the care co-ordinator in the EI. I felt like someone took an interest . . . someone cared about the care I was getting [because of the joint meeting].'
Complementing the support offered by designated lead professionals, young people interviewed in the SCIE practice enquiry said that they valued peer support groups and voluntary sector advocates. Voluntary sector staff can often provide support to professionals in arranging this. For example, one advocate was able to accompany a young person to weekly meetings with statutory services, and another young person using services said about her peer support:
'I went to a support group meeting with other young people like me so I felt less alone … I began to understand what it was all about. I can dip in and out of the group now as I want to.' Angela, Liverpool
- Lincoln team co-ordinators manage multi-disciplinary locality teams and have a key role in ensuring smooth transitions and improving information-sharing between teams.
- Central Norfolk EIT has created a team of staff to co-ordinate referrals.
- Leeds CAMHS has commissioned two dedicated transition worker posts to engage with young people aged 16 and over and their families where it is likely the young person will need mental health support from adult services after 18 years of age. Adult services include AMHS, social care, education and the voluntary sector. The first steps were to map adult services and to give a questionnaire to young people and their parents/carers. The transition workers are primarily involved with young people aged 17.5 to 18.5 years during the service transition period, with robust transition planning taking about six months for most young people. They also work jointly across services, for example attending team meetings of community mental health teams in AMHS.
- The Camden and Islington EIS demonstrated age-appropriate services and continuity of care in the case of a 16-year-old girl admitted to an adolescent inpatient unit where she was diagnosed with bipolar affective disorder. The EIS CAMHS team kept a close eye on her, were aware of her discharge plans, and were able to implement these post-discharge. Once the girl was 18, the crisis team was brought in to work alongside EIS to provide intensive home treatment to improve medication compliance. She was admitted to an adult ward where again the EIS CAMHS team remained involved with her care to give a CAMHS perspective. She was discharged after a few weeks, again to the EIS CAMHS team, and now has positive outcomes in terms of mental health, college and relationships.
Adult social care and AMHS often have different eligibility criteria from CAMHS.For example, CAMHS may adopt a preventative and early intervention approach by accepting children and young people with a wide range of psychological and emotional problems such as anxiety, conduct disorder, emerging personality disorder, ADHD and ASDs, and other mental health problems for which there is no medical diagnosis, or an uncertain diagnosis. On the other hand, AMHS may only accept adults with a firm diagnosis of severe and enduring mental health problems, leaving young people without a service. This results in many young people not using or being unable to access statutory mental health services in spite of ongoing needs. This group of young people face future crises and serious increased risk to their stability, wellbeing and future lives. This in turn may adversely affect both them and their families and friends, now and in the future.
Transition from CAMHS to AMHS does not need to be automatic; young people who do not have severe and enduring mental health problems may not need AMHS, 'but' they may need support in young adulthood from other sources including non-health settings, voluntary sector and primary/universal services.
Eligibility criteria are perceived by young people and their families to bring sudden and often rigid changes, which they often do not understand or accept, and consequently interpret negatively:
'It was like they [social services] thought “You're 18 now, you're an adult”. But no I wasn't. We're all different; to go on age . . . it's just not going to work.' Hassan, Liverpool
'As soon as I reached 18 I felt like the service was not interested in me.' Samantha, Cornwall
In addition to sudden and strict eligibility criteria there are often other problems, including:
- long waiting lists for AMHS and adult social care, even when a young person is eligible
- the lack of services for young adults who may not be eligible for AMHS or need extra support in addition to AMHS.
The practice enquiry found one young person who, although having a range of complex needs, was not eligible for social care support once he had turned 18. The reason given was that adult social care services considered his diagnosis made him eligible for health services, not social care - however, this young person was not eligible for AMHS support either.