Mental health service transitions for young people
Service styles, models and barriers: Service models which smooth transition pathways
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.
Services and pathways which straddle the service transition period of 16-18 years, and provide services up to the age of 25, can help to overcome some of the barriers described above. Young people want flexible services which do not have strict 'cut-off' points and these services are especially important for young people with emotional problems, complex needs, mild learning disability, ADHD and ASDs, for whom there are limited statutory adult services beyond GPs.
In addition to a growing number of 'youth mental health services' providing care and treatment for 18-25-year-olds, early intervention services for psychosis, some with a specific focus on supporting young people with first onset psychosis, have developed over the past 10 years. These teams cover the age range from 14 to 35, bridging CAMHS and AMHS, and service transitions can occur at older ages. The underpinning belief is that intervening early, and minimising the duration of untreated psychosis, greatly improves longer-term outcomes. SCIE's advisory group thought that transition is often negotiated more successfully over the age of 25, and many young people may no longer require services at that point, countering the view that this model would just delay transition. On the contrary, it could prevent premature disengagement and more serious problems developing later on.
Young people and their families want consistent services and continuity of support during transition. They will often benefit from a period of parallel care or overlapping service delivery between CAMHS and adult services. Commissioning arrangements should reflect this.
Young people may need extra support - for example, advocacy, to stand up for their needs in adult services, which can be less supporting and nurturing than CAMHS.
SCIE's practice enquiry highlighted a number of working arrangements and service models which can help to overcome problems. These will need to be supported by budgets and commissioning arrangements:
- Consistent professional support from a lead professional to plan and manage the service transition.
- Links with primary care including GPs who may be a young person's sole source of support.
- Joint working arrangements - for example protocols, information-sharing, joint appointments and transparent multi-agency planning meetings with young people, sometimes called 'transition clinics'.
- Flexible services which:
- can be stepped up and down according to need and don't taper off suddenly - keep young people 'on their books' even if they don't need services at the moment - use 'assertive outreach' active techniques to initiate and maintain engagement with young people who need it.
- Peer contact, mentoring and advocates to provide support.
- Links with non-statutory agencies - for example, staff from supported housing and voluntary sector agencies who accompany young people to appointments.
- Flexible solutions which focus on individual needs rather than a one-size-fits-all approach. For example, some young adults may prefer a quarterly appointment with a psychiatrist rather than the intensive input more typical of community mental health team pathways for adults with severe and enduring illness.
- Some statutory services run dedicated transition or 16-18 services, sometimes with multi-disciplinary and multi-agency membership.
- Some services in the voluntary or third sector work specifically with young people up to 25 years, providing multi- disciplinary, flexible 'wrap-around' support as young people make the transition to adult life. This includes the YIACS model. These services can provide a critical 'holding function' for those young people not accepted by AMHS and who don't have any other form of support, and can link with CAMHS, AMHS and other services.
- Both statutory and voluntary sector services can form key partnerships with other services for young people such as GPs, Connexions, youth clubs, colleges/education institutions, employment support, benefits advice, supported housing services, etc.
- Both statutory and voluntary sector services can use a professional mix to provide youth-focused flexible support, with social and psychological support in addition to medication.
- Third sector organisations advocating for young people and presenting individual cases may help young people to receive the social care funding they need.
- Central Norfolk EIT allows young people to receive a service for five years to enable a smooth transition to AMHS or to primary care.
- Leeds Transition Service increased the age of CAMHS service users from 17 to 18. CAMHS and AMHS managers and clinicians meet regularly to review their transition protocols and to practice.