Mental health transitions for young people: challenges and solutions Dr Yvonne Anderson NHS Improving Quality held an event in London on 31 July 2013 to progress the children and young people transition to adult services work with a focus on turning the rhetoric into practice entitled “Working to Define a Generic Service Specification for Transition”

1. Mental health transitions for young
people: challenges and solutions
Dr Yvonne Anderson

2. “The transition to
adulthood is becoming
more complex, longer
and more risky. It is a
time when young people
enter a new and exciting
world with new rights –
and responsibilities. It is
also the time when they
take decisions that will
affect the rest of their
lives.”
Social Exclusion Unit ,2005,
Transitions: Young adults with
complex needs

3. Over 10 years of reports and research
detailing poor transition
–
–
–
–
–
•
Track
YoungMinds SOS project
HASCAS Transitions Project
PHF/MHF Right Here
NSFs
Heightened focus from CAMHS
National Advisory Council
• Increased awareness of the
significance of transition as a
life stage and success of
Transition Support Programme

4. Why do young adults need a different
approach?
• Three great transitions: work to school, home to
independent living, parented to becoming
independent/a parent
• The brain is still changing, especially developing
impulse control
• Mental Health in adolescents is deteriorating - and
incidence rises from 1:10 in children to 1:6 in adults
• Patterns of service use and access develop early in
life, so how young people experience services when
they first use them will affect engagement as adults

5. Majority of serious mental health
problems typically commence in
young people

6. A taxonomy
Severe and enduring MH
Disorders recognised
by CAMHS not AMHS
Complex yp without
a diagnosis but
highly vulnerable
Adult Mental Health Services
Transition not guaranteed
ADHD, Mild to moderate LD, ASD
Not severe enough
Limited, patchy AMHS
YIACs and voluntary sector
Return to primary care
Voluntary sector
No service

7. The cost of not providing accessible
services
•
•
•
•
School/college/work breaks down
Crisis presentation
Family breakdown
Homelessness
Sources:
SEU,2003 2004, Whose Crisis
Layard ,2005, Mental health: Britain's biggest social problem?
Street, 2007, Pushed into the Shadows

8. We know what young people want ..

9. We know what young people want ..
• To be listened to and understood
• To be taken seriously
• A well planned service where the transition and
discharge arrangements happen smoothly , it shouldn’t
be left to us or our families to manage it
• Flexible services focused on developmental age rather
than chronological age and on our individual needs
• Choice , information and advice to help us make
informed choices about our care and to help us move on
• Honesty about what can and cant be kept confidential
• Continuity of care – it take time to build relationships
• We shouldn’t have to fight for our rights

10. What does a good service transition
look like?
• Information transfer
• Shared working for a period of time
• Transition planning – at least one meeting
between CAMHS, AMHS and young person
• Continuity – 3 months on maintained contact
with AMHS/appropriate discharge
Singh et al 2010 Track Study

11. No health without mental health
• Whole life course
• Explicit referral to
transitions
• Outcome iv
– young people’s
experience of
transitions

12. “Careful planning of the transfer of care between
services will prevent arbitrary discontinuities in care as
people reach key transitions. Services can improve
transitions, including from child and adolescent mental
health services into adult mental health services, or
back to primary care, by:
• Planning for transition early, listening to young
people and improving their self efficacy;
• Providing appropriate and sensible advice so that
young people can exercise choice effectively and
participate in decisions about which adult and other
services they receive; and
• Focusing on outcomes and improving joint
commissioning, to promote flexible services based on
developmental needs.” Page 25

13. Young People's Mental Health Service
Transitions project
• Commissioned jointly by DH Adult Mental Health
and Children and Families CAMHS Policy Teams
• Collaboration between National Mental Health
Development Unit (NMHDU), National CAMHS
Support Service (NCSS) and Social Care Institute
for excellence (SCIE)
• NCSS/NMHDU products delivered by March 2011
• SCIE products delivered by November 2011
• Supported by Virtual Expert Reference Group

14. Yvonne Anderson
y.anderson@cernis.co.uk
Author of e-learning (2011), co-producer of MH Transitions self
assessment tool (2011), author of HASCAS tools for transition
(2006)
Kathryn Pugh
Kathryn.Pugh@NHSIQ.nhs.uk
National lead for young people’s MH service transitions
project (to 2011), author of Stressed out and Struggling (2006)